products liability - Homeowners Service Request

DISCLAIMER

We are committed to protecting the personal privacy and security of individual consumers who seek or acquire products through one or more of our insurance programs primarily for personal, family, or household purposes ("Consumers"). While information is the cornerstone of our ability to provide you with superior service, we realize that our most important asset is your trust. Therefore, we have implemented strict privacy and security policies on our websites to ensure that no personal identifying information about individual consumers is accessible to the general public. For more details, please review our security statement below.

Depending on the type of insurance program offered to Consumers, your insurance agent/broker may submit personal information about you, others in your household and your vehicles to provide accurate insurance rates to us. This information may be submitted to us electronically via our website. Depending upon your state of residence, this information requested could include: zip code, date of birth, gender, marital status, prior insurance carrier, driving record, vehicle attributes, annual mileage, homeownership and employment. Additional information about you may be submitted to us if you purchase a policy. As permitted by law, we may confirm the information you provide through consumer reporting agencies, publically available records, appraisals or investigatory sources, and/or the Department of Motor Vehicles.

We do not sell any Consumer information to third parties. If you purchase a policy through one of our programs, we may share information about you with the following:

A third party if it is necessary to effect, administer, or enforce your insurance transaction, such as policy processing or claims administration;
Any of our affiliated companies who provide service to you;
Insurance regulatory or government authorities as required by law;
Law enforcement agencies to protect our interest or to report illegal activities;
In response to a valid legal subpoena or court order; and
Persons or organizations conducting actuarial or other statistical studies.


» Name
Address:
City:
State:
Zip:
» Home Phone:
Work Phone:
» Email:

Policy Number:
Policy change effective date (mm/dd/yy):
Change First Mortgage
Name:
Address:
Loan #:
Is first morgagee maintaining escrow to pay homeowners premium:	Yes No

Change Second Mortgage
Name:
Address:
Loan #:

Comments or other changes (please specify)