Electronic Communication Consent Form

New federal regulations recently came into effect requiring us to update our records regarding our means of communication with customers. To allow us to continue our communication regarding your insurance, via mobile phone, messages, e-mail, and any kind of online communications, we now need to document your consent.

Insured Name:

Email Address:

Cell Phone:

Insurance Related Information

I understand that Progress Preferred Insurance, Inc. can reach me to remind me of my Insurance Related Information, Renewals, Changes, or Cancellations. And I also understand that the Company can employ and use a third-party automated system to reach out to me for the purpose of insurance policy service.

Contact Information Change

I accept that I am responsible of notifying Progress Preferred Insurance, Inc. when my contact
information change.

Consent Cancellations

I know that I can revoke this consent at any time by contacting Progress Preferred Insurance, Inc. and I can Opt-out from receiving text messages by replying “Stop”.

Date:

I hereby consent to receive calls, texts and emails regarding insurance related updates, changes, reminders, renewals, cancelations, and other important information from or on behalf of Progress Preferred Insurance, Inc. at the telephone number and email provided above. I agree to Progress Preferred Insurance, Inc. terms and conditions. (Required)

Field with asterisks(*) are required.