Consent to Receive Electronic Records

(pursuant to 15 USCA Section 7001(c))

Please read this information carefully and print a copy and/or retain this information electronically for future reference.

Introduction. From time to time Stork Insurance Agency may utilize the Internet, email, digital media or the like to transmit policy documents and related information to policyholders. This consent to receive electronic records informs you of your rights when conducting these transactions electronically with this agency and those third parties to which we may forward your requests, information or applications. By consenting below, you acknowledge receipt of this consent to receive electronic records and agree to the electronic delivery of any disclosures, policy forms and documents, information or notices required by federal law including any adverse action notices or privacy policy notices (hereinafter “records”) at our website or through the electronic mail address you provide.

Hardware and software requirements. Before agreeing to receive records electronically, you must determine if you have the necessary hardware and software to access and retain these records electronically. To retain your records, your access device must have the ability to download to your hard drive or any external media storage, or print the records as well as embedded HTML files.

Right to withdraw consent and procedures for withdrawal. You may withdraw your consent to receive your records electronically at any time by sending an email to stork [at] storkinsurance [dot] com. With the exception of email communications, your transaction will continue to be processed in non-electronic form at no charge. Withdrawal of your consent shall not affect the legal effectiveness, validity or enforceability of electronic records provided or made available to you prior to implementation of your withdrawal of consent. Your withdrawal of consent shall be effective within 30 days after receipt of the withdrawal request by us.

Consent applies to categories of records. Your consent to electronic records applies to all policy documents, applications or any information related to your policy. You will receive any records required by federal law at this website or through the electronic mail address you provide.

Option to obtain paper copies of records. You have the option to request that we provide you with paper copies of those records we provide to you electronically at this website or through the electronic mail address you provide. If you wish to obtain the records in non-electronic form, send your request via email to stork [at] storkinsurance [dot] com and provide your mailing address. We will not charge you for the paper copies of the records.

CONSENT AND ACKNOWLEDGMENT. BY CLICKING “I AGREE” THROUGH DOCUSIGN OR IN PERSON, YOU ACKNOWLEDGE THAT YOU CAN ACCESS AND RETAIN THE ELECTRONIC RECORDS IN THE FORMAT DESCRIBED ABOVE, AND YOU CONSENT TO HAVING US PROVIDE DOCUMENTS TO YOU ELECTRONICALLY VIA EMAIL OR OTHER ELECTRONIC MEDIA.