This notice is to inform you of the nonpublic personal information about you that we may lawfully share with others. 
This notice is also to inform you of your rights regarding the disclosure of your nonpublic personal information.


Your nonpublic personal information may be disclosed for the purpose of offering products or services to you.


We collect nonpublic personal information about you from:


            Applications or other forms you complete;

            Your business dealings with us and our companies;

            Consumer reporting agencies; and

            Claims databases, such as the Comprehensive Loss Underwriting Exchange.


We may share nonpublic personal information about you, including:


Information from your application or other forms, such as your name, date of birth, address, age, social security number;

Information about your transactions with us, our affiliates or others, such as your policy coverage, premiums and payment history; and

            Information from consumer reporting agencies, such as your credit history.


We may share your nonpublic personal information with:


            Our affiliated companies, which means any person or entity that is an affiliate of,

            or related by common ownership, or affiliated by corporate control, with us;

            Financial companies, such as mortgage bankers and automobile insurers.


Rest assured, we protect your nonpublic personal information.  The only employees who have access to that information are those who must have it to provide products or services to you.  Additionally, you have the right to access and to request correction of your recorded nonpublic personal information.  Simply contact us if you would like to access or correct your nonpublic personal information.


Nonetheless, under certain circumstances, you have the right to prevent the disclosure of your nonpublic personal information.  This is known as ‘opting out.’


If you don’t want us to disclose nonpublic personal information about you to nonaffiliated companies, you may tell us so by ‘opting out.’  If you wish to opt out check the option at the bottom of this form.  You may opt out at any time.  Even if you opt out, we may still disclose information as allowed by law.


I have received and read the above notice and I understand and agree to its provisions.


Signature:_____________________                                            Date:__________ 


I choose to opt out:  _____