This is the Website of		Company Name
Our postal address is		Address
Our location		City, State, Zip
We can be reached via  email at		email
Or you can reach us by  telephone at		Phone
*This Policy is effective on:		Insert effective date of policy

	the consumer's domain name and email address (where possible)
	only the consumer's domain name, but not the email address (where possible)
	no information regarding the domain or email address
	other

*3. We collect...
(choose all that apply)

	only the domain name, but not the email address of visitors to our Web page
	the domain name and email address (where possible) of visitors to our Web page
	the email addresses of those who post messages to our bulletin board
	the email addresses of those who communicate with us via email
	the email addresses of those who make postings to our chat areas
	aggregate information on what pages consumers access or visit
	user-specific information on what pages consumers access or visit
	information volunteered by the consumer, such as preferences, survey information and/or site registrations
	name and address
	telephone number
	fax number
	payment information (e.g., credit card number and billing address)
	no information on consumers who browse our Web page.
	other

	used for internal review and is then discarded
	used to improve the content of our Web page
	used to customize the content and/or layout of our page for each individual visitor
	used to notify visitors about updates to our Website
	shared with agents or contractors who assist in providing support for our internal operations
	used by us to contact consumers for marketing purposes
	shared with other reputable organizations to help them contact consumers for marketing purposes
	not shared with other organizations for commercial purposes.
	disclosed when legally required to do so, at the request of governmental authorities conducting an investigation, to verify or enforce compliance with the policies governing our Website and applicable laws, or to protect against misuse or unauthorized use of our Website
	to a successor entity in connection with a corporate merger, consolidation, sale of assets, or other corporate change respecting the Website
	other

	We do not set any cookies
	We use cookies to . . . (choose all that apply)

	store visitors preferences
	record session information, such as items that consumers add to their shopping cart.
	record user-specific information on what pages users access or visit
	alert visitors to new areas that we think might be of interest to them when they return to our site
	to record past activity at a site in order to provide better service when visitors return to our site
	ensure that visitors are not repeatedly sent the same banner ads
	customize Web page content on visitors’ browser type or other information that the visitor sends
	other

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

... and telling us that you do not want to receive email from our company.

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

... and telling us that you do not want us to share your email address with other companies.

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

(1) you will only receive the information for which you provided us your address

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

(3) you may receive mailings from other reputable companies. You can, however, have your name put on our do-not-share list by (choose all that apply)

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

Please provide us with your exact name and address. We will be sure your name is removed from the list we share with other organizations.

	will only receive telephone contact from us with information regarding orders they have placed on-line.
	may receive telephone contact from us with information regarding new products and services or upcoming events. If you do not wish to receive such telephone calls, please let us know by.. (choose all that apply).

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

Please provide us with your name and phone number. We will be sure your name is removed from the list we share with other organizations.

	We do not partner with or have special relationships with any ad server companies
	To try and bring you offers that are of interest to you, we have relationships with other companies that we allow to place ads on our Web pages. As a result of your visit to our site, ad server companies may collect information such as your domain type, your IP address, and clickstream information. For further information, consult the privacy policies of: (Please list the URLs for the privacy statements of the ad server companies with whom you have contracted or partnered)

	we will contact you before we use your data for these new purposes to notify you of the policy change and to provide you with the ability to opt out of these new uses
	we will post the policy changes to our Website to notify you of these changes and provide you with the ability to opt out of these new uses. If you are concerned about how your information is used, you should check back at our Website periodically.
	we will post the policy changes to our Website to notify you of these changes and we will use for these new purposes only data collected from the time of the policy change forward. If you are concerned about how your information is used, you should check back at our Website periodically
	Other (insert means of communicating updates to privacy policy)

Customers may prevent their information from being used for purposes other than those for which it was originally collected by:

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

	all information [including proprietary information] that we maintain about them
	financial information (e.g., credit card account information) that we maintain about them
	unique identifier information (e.g., customer number or password) that we maintain about them
	transaction information (e.g., dates on which customers made purchases, amounts and types of purchases) that we maintain about them
	communications that the consumer/visitor has directed to our site (e.g., emails, customer inquiries)
	contact information (e.g., name, address, phone number) that we maintain about them
	a description of information that we maintain about them
	no information that we have collected and that we maintain about them

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

	no ability to have factual inaccuracies corrected in information that we maintain about them
	the ability to have inaccuracies corrected in…. (choose all that apply)

	contact information
	financial information
	unique identifiers
	transaction information
	communications that the consumer/visitor has directed to the site
	all information that we maintain

Consumers can have this information corrected by (choose all that apply)

	sending us email at the above address
	calling us at the above telephone number
	writing to us at the above address
	visiting the following URL
	other (please explain)

	When we transfer and receive certain types of sensitive information such as financial or health information, we redirect visitors to a secure server and will notify visitors through a pop-up screen on our site.
	We have appropriate security measures in place in our physical facilities to protect against the loss, misuse, or alteration of information that we have collected from you at our site
	Other (please explain if you wish to specify)

	Us at the above addresses or phone number;
	The DMA’s Committee on Ethical Business Practices at mgoldberger@the-DMA.org;
	State or local chapters of the Better Business Bureau;
	State or local consumer protection office; or
	The Federal Trade Commission by phone at 202-FTC-HELP (202-382-4357) or electronically at http://www.ftc.gov/ro/romap2.htm
	Other