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Trinity Insurance Services LLC
Electronic Disclosure and Consent Form

 

Yes, I would like to receive my policy and endorsements for my Insurance policies electronically!

This Electronic Disclosure and Consent form contains information about how we will deliver your policy information, disclosures and applicable account notices electronically as required by applicable law.

Consent to Electronic Delivery.  By signing below, you consent to receive and acknowledge that you can access, receive and retain all notices, statements, and disclosures electronically whether sent by e-mail or other electronic means and acknowledge that you will no longer receive paper copies. You are not required to do business electronically.

Electronic Policy Information. By signing below, you acknowledge that you would prefer to receive your policy via the client login on our website or thru your email account.

If you currently receive a combined statement for your accounts you acknowledge and agree to receive notices, statements and disclosures electronically for all of the other accounts appearing on the combined statement.

You may request a paper copy of any policy by contacting our office at 888-391-0416.

You agree to print our to download this notice, all the Required Information, and all other Transaction Information we display for you and keep copies for your records. If you have any trouble with printing or downloading, you may call your Customer Representative and request paper copies at 888-391-0416.

By accessing the website and following the links provided, you are affirming that your PC meets the hardware and software requirements necessary for receiving notices, statements, policies, and disclosures.

You will have the option to download a complete copy of your policy information and other Transaction information in an Adobe Acrobat PDF File.

To download and view your documents using the Adobe Acrobat PDF File, Adobe Acrobat Reader must be installed on your system. Adobe Acrobat Reader 7.0 is available for free download from www.adobe.com.

Your policy, endorsements, and certificates are accessible and retain thru our secure online client login during the effective dates of the policy.

Trinity Insurance Services LLC agrees to provide a notice to you in the event of any changes regarding hardware or software requirements necessary to receive policies, endorsements, etc. And disclosures electronically.

Receiving Electronic Notices, Statements, and Disclosures. We will send you an email notifying you that your policy or endorsement is ready for viewing. In order to access your Policy, you will need to login thru the client login portal on our website (www.trinityins.net). Upon successfully logging on to the client logon portal, you will see a link for your policy and/or endorsements.

Withdrawal of Consent to Electronic Notices and Statements. If you agree to receive policies and endorsements electronically you can withdraw your consent at any time in writing to our office at 888-415-0671. Upon written withdrawal of consent, you will begin receiving paper policies immediately. Withdrawal of your consent will not affect the legal validity and enforceability of any policy statement or disclosure previously received electronically.

 Notification of Changes. You agree to notify us promptly if your mailing address, e-mail address or other information changes by contacting our office at 888-391-0416.

I consent to the use of Electronic Records in connection with my insurance policy. I have been able to read this notice using my computer software. I have successfully printed or downloaded a copy of this notice. I have access to an account with an Internet service provider, and I am able to send and receive e-mail. [I am consenting on behalf of all joint applicants identified in the application. I am authorized to consent on their behalf.]

I consent

X: _____________________________

 

I do not want to conduct this transaction electronically

X: ____________________________________

 If you wish to print this page, sign and fax. Please fax to 1-888-415-0671
 

 
Or Sign Electronically,
Accept: by checking this box you accept the terms.
Your Name:

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TRINITY INSURANCE SERVICES, LLC
dba in California as Trinity Commercial Insurance Services LLC & in New York as Trinity Commercial Insurance Services LLC