ELECTRONIC DELIVERY & COMMUNICATION CONSENT
Bushinger Bucciero & Smith Agency, Inc. Voice & Text: 315-737-7348
9528 Pinnacle Road, Sauquoit, NY 13456 Email: [email protected]
- Consent to Electronic Delivery
Your use of this contact form constitutes your consent to receive insurance-related documents and communications electronically from Bushinger Bucciero & Smith Agency Inc. This includes, but is not limited to the following AGENCY communications:
| • Policies and Endorsements | • Quotes |
| • Notices of Cancellation or Non-renewal | • Required Regulatory Disclosures |
| • Billing Statements and Payment Confirmations | • Policy- & Claim-related Correspondence |
- Scope of Consent
This consent applies to all current and future policies quoted or issued to me by or through Bushinger Bucciero & Smith Agency Inc, unless I withdraw consent in writing. I understand that:
- Electronic documents will be considered delivered when sent to the email address or mobile number I provide.
- It is my responsibility to maintain a current and valid email address and mobile number on file.
- Failure to receive an electronic notice due to outdated contact information does not invalidate the delivery.
- Hardware & Software Requirements (E-SIGN Disclosure)
To access and retain electronic records, I must have:
| • A device capable of accessing email | • A device capable of receiving SMS/MMS text messages |
| • Internet access | • The ability to download or print documents |
- SMS/MMS/Text Message Consent
By providing my mobile number:
- I authorize Bushinger Bucciero & Smith Agency Inc to send insurance-related communications via text message.
- Message and data rates may apply.
- Message frequency may vary with level of service required on your account.
- Consent is not a condition of purchase.
- I may opt out at any time by replying STOP.
This consent complies with applicable federal and New York telecommunication laws.
- Right to Withdraw Consent
I may withdraw my consent to electronic delivery at any time by providing written notice to:
Bushinger Bucciero & Smith Agency – 9528 Pinnacle Road, Sauquoit, NY 13456 – 315-737-7348
Withdrawal will apply prospectively and does not affect documents previously delivered electronically.
I may opt out of receiving text messages at any time by texting STOP to stop messaging.
I may text HELP for help.
- Request for Paper Copies
I may request a paper copy of any electronically delivered document by contacting the agency. Reasonable administrative fees may apply, if permitted by law.
- Acknowledgment
By signing below, I confirm that:
- I have read and understand this Electronic Delivery & Communication Consent.
- I consent to receive insurance documents and communications electronically.
- I confirm that I can access electronic documents as described above.
- The email address and/or mobile number I provided is accurate.
- Our Privacy Policy (link)
