Are you requesting information on behalf of another person? *
Yes
No
What is your relationship with the person? *
Please fill out this field.
I have Power of Attorney for the person
I am an authorized representative of the person
What is your relationship with Tri Counties Bank? *
Current customer/client or other account holder
Former customer/client or previously applied for an account
Never had an account
Current/former applicant, employee of Tri Counties Bank
Other
Request Type *
I want to request personal information that has been collected or shared
I want to request that personal information be deleted
First Name *
Middle Initial
Last Name *
Suffix
How would you like us to respond *
Email
Postal Mail
Email
Address Line 1
Address Line 2
City
State
Zip
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