OPT ME OUT NOTE: If your company has multiple owners who do not wish to share in the distribution, please complete and submit one “Opt Me Out” form for each owner of the company.NAME (To Opt-Out of Distribution)(Required) COMPANY(Required) GOLDEN OAK MEMBERSHIP NUMBER(Required) ADDRESS (To Opt-Out of Distribution)(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PHONE(Required)EMAIL(Required)SOCIAL SECURITY #(Required) CONTRACTORS LICENSE #(Required) I certify that I have decided to opt-out of any distribution for which I may be eligible.Ownership percent SIGNATURE (type your full name)(Required) By typing your name and submitting this form you are providing authorization to opt-out.DATE(Required) Δ
