This video tape service provider from time to time provides to marketers of goods and services, the names and addresses of customers and a description or subject matter of materials rented by video customers. You have the right to elect not to have your name, address or the description or subject matter of any material rented included in such lists. This election may be changed by you, in writing, at any time.
I do not object to the release of my name, address or the description or subject matter of the material rented.
________________________________ Signature
I do object to the release of such information.
________________________________ Signature
N.Y. Gen. Bus. Law § 672