Mehrbrodt Insurance Service, Inc.
Your Local Authorized Mercury Agent Since 1971
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Mehrbrodt Insurance Service, Inc.
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Your privacy is important to us. At
MEHRBRODT INSURANCE SERVICE, Inc., we are committed to protecting your privacy and
earning your trust. We respect your right to keep your personal information
confidential and to avoid unwanted solicitations. Please read this to learn how
we will handle your personal information, and the information of others insured
on your policy.
IMPORTANT PRIVACY CHOICES
REGARDING YOUR NONPUBLIC PERSONAL
INFORMATION
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:
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Applications or other forms you complete; !
Your business dealings with us and other 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, and assets; !
Information about your transactions with us, our affiliates or others,
such as your policy coverage, premiums, and payment 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 life insurers, automobile insurers, mortgage
bankers, mortgage companies, lien holders, and insurance agents. 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, call us at 1-888-622-5700, or mark the box at the bottom of
this form and return it to us. We may share information about you if we do
not hear from you within 30 days.
However, you may opt out at any time. Even if you opt out, we may still
disclose information as allowed by law. This includes disclosing information to
our affiliates to market other products or services to you. In the case of joint
policy holders, if any joint policy holder opts out, the opt out will apply to
all joint policyholders. If all joint
policyholders reside at the same address, one opt-out notice form will be
provided on a joint basis.
I
have received and read the above notice and I understand and agree to its
provisions. Print
Name:__________________________________________________________________________ Signature:___________________________________________________
Date:____________________ ___ I choose to opt out (check box) Revised 1-1-2007 |
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Mehrbrodt Insurance Service, Inc. 930 N Grand Ave. Suite B Covina, CA 91724 Voice: 626-915-5179 Fax: 626-966-0814 DOI Lic# 0F50022 Click here to send us an email
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