Information Release Form

As part of the application process in obtaining the insurance coverage you are requesting, the automobile insurance company and/or its agents may order one or more consumer reports. A consumer report may contain information on credit history, medical conditions, driving records, criminal activity and hazardous sports, among other things.

Under the Fair Credit Reporting Act, the automobile insurance company and/or its agents may review consumer reports to evaluate anyone who applies for insurance. In the event that coverage is denied based wholly or partly on information in a consumer report you will be notified of this fact, and given the name and address of the consumer reporting agency making the report.

In consideration of the above, your signature below acknowledges your release for the automobile insurance company.

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