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No coverage is afforded until such time as written confirmation is provided by
Consumers Insurance Agency, Inc.
While Consumers Insurance Agency, Inc. is licensed to sell insurance in the entire
Commonwealth of Pennsylvania, we are able to best service those personal lines customers
in areas close to our offices in the south central part of the state.
In order to determine what coverage is available to you, and at what price, and to help
the insurance company evaluate your personal risk, we will be asking you some questions
concerning claim history, driving record, and credit history. Insurance companies offer
better pricing for prospective clients with excellent driving records and loss free claim
history. In addition, some companies, in some states, offer a better price for persons
with acceptable Insurance Scores, which measure the likelihood of an insurance loss based
on financial behavior, according to credit report information. By completing this quote
request form, you are acknowledging and giving your permission for any or all of the
following information or reports to be obtained:
MVR (Motor Vehicle Record): State driving records which may include driver’s
license information including violations, convictions, revocations and suspension
information, as well as personal information such as address and date of birth.
ADDITIONAL DRIVER DISCOVERY (ADD): is a database of all licensed drivers in the
household. This report helps determine that all drivers in the household have been
disclosed on the quote request or application so that appropriate evaluations and premium
charges for all drivers can be made by the insurance company.
CLUE (Comprehensive Loss Underwriting Exchange): is a database of information
containing claims history by individual, by driver, by policy,by vehicle, and by location
address.
INSURANCE SCORE: This evaluates many aspects of your credit management history,
including, but not limited to: number of open accounts, payment history, frequency of
recent inquiries into the credit report, etc. In particular the model considers the
presence of any major financial blemishes such as bankruptcy, liens, foreclosures, etc.
Neither our agency, nor the insurance company actually receives a copy of your credit
history or report. We simply receive an Insurance Score of "Acceptable" or
"Not Acceptable." If a consumer has been denied insurance in the past sixty days
based on information contained in a credit report, the Federal Fair Credit Reporting Act
requires the credit bureaus to provide a copy of the credit report to you free of charge.
You also have the opportunity to check for any inaccuracies or erroneous information.
Customers who wish to receive a copy of their credit reports should contact ChoicePoint by
calling 1-800-456-6004, or by writing:
ChoicePoint
P.O. Box 105108
Atlanta, GA 30348-5108
NOTICE OF INFORMATION PRACTICES (PRIVACY)
Privacy Notification: Any information which we have or may obtain about you or other
individuals listed as policyholders on your policy will be treated confidentially.
However, this information, as well as other personal privileged information subsequently
collected, may, under certain circumstances, be disclosed without prior authorization to
third parties such as to our affiliated companies for claims handling, servicing,
underwriting, and insurance marketing. Personal information also may be disclosed to
affiliated and non-affiliated companies for non- insurance marketing purposes, unless you
write to us at the address provided with your policy and direct us not to make such
disclosure.
You have the right to see personal information collected about you, and you have the
right to correct any information which may be wrong.
If you are interested in obtaining a description of our information practices and your
rights regarding information we collect, please write us.
FRAUD STATEMENT
Any person who knowingly and with intent to defraud any insurance company or other
person files an application for insurance or statement of claim containing any materially
false information or conceals for the purpose of misleading, information concerning any
fact material thereto commits a fraudulent insurance act, which is a crime and subjects
the person to criminal and civil penalties.
Information submitted subject to verification. By proceeding with the quote request I
am acknowledging that I have read and understand the above information, and give my
express permission to obtain such information to evaluate my personal insurance. Quotation
may vary from coverage requested.
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