MidFirst Bank California Personal Information Request Who is submitting this request? (an Authorized Agent is someone who has been given signed permission to submit a request on another consumer's behalf.)* Please Choose Myself Authorized Agent Is this request associated with a business, consumer or employer/employee or applicant relationship? Check all that apply* Business Consumer Employer/Employee or Applicant Are you a customer or former customer of MidFirst Bank or any of its divisions (divisions include 1st Century Bank, Midland Mortgage, MidFirst Business Credit, MidFirst Direct, Vio and Monifi)?* Please Select Current Customer Former Customer Never a Customer Which division of MidFirst do you have a relationship with? Check all that apply MidFirst Bank 1st Century Bank Midland Mortgage MidFirst Business Credit MidFirst Direct Vio Bank Monifi What types of products or services do/did you have at MidFirst or any of its divisions? Check all that apply Deposit Account Credit Card Loan Mortgage Investments Please select your request type(s) Check all that apply I want access to personal information that has been collected or shared. I want to request that personal information be deleted. I want to request that you correct personal information you have on file for me. Your Information First Name* Middle Initial Last Name* Suffix Phone Date of Birth* Email Address* Re-Enter Email Address* Street Address* Apartment or Suite Number City* State* Please Select AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY Zip Code* Last four of SSN* Account/Loan Number (if applicable) How do you want us to respond to your request?* Please Select Email Postal Mail
