Tri Counties Bank

All fields marked with an asterisk (*) are required.

Are you requesting information on behalf of another person? *

Yes

No

What is your relationship with the person?

I have Power of Attorney for the person

I am an authorized representative of the person

I am a Tri Counties Bank employee filling out this request on behalf of someone else and have identified the subject of this request in accordance with Bank policy

Employee Name

What is your relationship with Tri Counties Bank? *

Current customer/client or other account holder

Former customer/client or previously applied for an account

Current/former applicant, employee of Tri Counties Bank

If you also want information about your bank accounts with Tri Counites Bank, please submit a separate request.

Never had an account

Other

Personal Account/Loan/Line

Business Account/Loan/Line

Tell us more about your relationship with Tri Counties Bank

Request Type *

I want to request personal information that has been collected or shared

I want to request that personal information be deleted

I want to request that inaccurate personal information be corrected

Are you, or the person on who's behalf you are making this request, a California Resident? *

Yes

No

If the subject of this request is a resident of the United States, please specify state of residence. If the subject of this request is a resident of another country, please indicate country of residence.

First Name *

Middle Initial

Last Name *

Suffix

Phone *

How would you like us to respond? *

Email

Postal Mail

Email

Address Line 1

Address Line 2

City

State

Zip

Your request will be processed within 45 calendar days.