Marketing Consent Form

• Purpose (i.e. mortgage testimonial, Bank Locally video, etc.) *
• Primary Customer’s First Name *
• Primary Customer’s Last Name *
• Secondary Customer’s First Name
• Secondary Customer’s Last Name
• Business Name (if applicable)
• Address Line 1 *
• Address Line 2
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• ZIP *
• Email address *
• Statement (if this is a testimonial, please describe why you’re happy you chose Forte Bank, what you love about your loan officer or personal banker or what you love about Forte Bank)

File Upload

If you are sharing a photo or video file with us, please upload that below.

Authorization to use image/information in public communications

I hereby consent and authorize Forte Bank to reproduce, exhibit, publish, circulate, distribute and otherwise use for marketing purposes any of the following: (in full or in part) my name, portrait or photograph, written statement, any photographic, video, film, and/or audio recordings made of me or my likeness, and/or any written extract of such recordings in which I may be included, for use in any medium now known or in the future invented, specifically including: magazines, newspapers, publications, booklets, circulars, billboards, CD-ROM, electronic media, social media, radio and/or television scripts, radio broadcast transcriptions, and/or telecast. I hereby release, discharge, and agree to hold harmless Forte Bank and all persons acting under its permission or authority of and from any and all rights, claims, demands, actions, suits, liability or injury that I may or can have against Forte Bank on the account of the use, or publication of said material.

• Authorize/Consent *
  Yes