Mail-in Form
If you have a joint account, your choice(s) will apply to everyone on your account unless you mark below q Apply my choices only to me	Mark any/all you want to limit: q Do not share information about my creditworthiness with your affiliates for their everyday business purposes. q Do not allow your affiliates to use my personal information to market to me.
	Name	Mail to: Valley Bank and Trust Co. 1425 10^th Street P.O. Box 538 Gering, NE 69341
	Address
	City, State,  Zip
	Account #