Financial App Data Access Revocation Request Form
Submit this form to request the removal of a financial app’s access to your personal data. Please provide accurate information to process your request efficiently.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Financial App
*
Type of Data Access to Revoke
*
Account Information
Transaction History
Personal Details
Other
Reason for Revocation
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Contact Method for Confirmation
*
Email
Phone
I confirm that I am the authorized user requesting revocation of this app’s data access.
*
I confirm
Signature
Submit Revocation Request
Submit Revocation Request
Should be Empty: