Demand Notice

a Recession and Creation of a New Contract

Name and address of person making this demand (I or me) Name and address of person, company or entity upon whom the demand is being
made (you or your)

You are hereby directed to provide copies of any and all information contained within any of your
files pertaining to the person making this demand. Since my name and address is particularly
unique, it suffices as complete, necessary and sufficient identification (15 USC 1681h).
Be advised: I consider all information associated with me, including but not limited to, my name,
accounts, addresses, phone numbers, and associated identity numbers, as well as numbers,
characters and/or similar symbolic arrangements to be personal, confidential, and uniquely mine.
As such, arrangement must be made with me to use or store such information. Any permission
and/or authorization you think you may have had, regarding the use and/or storage of such
information, is hereby revoked and a new agreement is constituted beginning this day.
You Are Entering a Binding Contract
You are hereby granted permission to use and/or store such information and/or data while you
compensate me at a rate of $500.00 per month due and payable on the first day of each month plus
a 2% monthly interest rate on unpaid balance, plus $50.00 per occurrence late charge, plus a
$100.00 billing fee. OR:
You are hereby advised that you do not have my permission to store information regarding me or
information attributed to or about me. Therefore you are hereby ordered to remove and purge any
such data or information from your filling systems.
Furthermore: Any permission, right, or privilege you think you may have had to store information
or data regarding me is here by revoked.
Furthermore: You are not authorized and do not have permission to use, for any reason, a
number similar to such number the Social Security Administration may have assigned to me.
Furthermore: You are hereby ordered to forward and advise me of any and all inquiries made
regarding data or information which another party thinks you may have about me.
Furthermore: Since this order directs you to purge your records of any data and/or information
regarding me, it is further expected, and you are hereby ordered to stop selling and/or sharing such
information with any other person or organization.
Notice: Failure to notify me in writing, within forty-five (45) days of the date shown
below, that you have purged from your files and storage devices all information
and/or data regarding or associated with me, is regarded as your acceptance of these
terms and your agreement to compensate me as indicated above.
Signed and executed this day number of month , year by your typed name

your signature here

Public Domain–CRA(01)-1999