Bank Public Injunctive Relief Waiver Acknowledgement

Bank Public Injunctive Relief Waiver Acknowledgement
Please complete this form to acknowledge and consent to waiving your right to seek public injunctive relief in disputes with the bank.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you completing this form as:
Other
Select the bank service related to this acknowledgement:
Please specify the reason for submitting this waiver acknowledgement:
Please provide any additional comments or context (optional):
Date of Acknowledgement
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
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