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Cell Phone:
City:
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Fax:
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Best Way To Contact You:
Home Phone Cell Phone Work Phone Fax Mail Email If By Phone, Best Time To Call:
Interest:
Personal Auto
Homeowners
Cycle/Boat/ATV
Farm
Business
Commercial Auto
Workers Compensation
Life
Disability
Individual Health
Long Term Care
Medicare Supplement
Group - Health, Dental, Vision, Life, & Disability
Retirement Plans - 401K, IRA
Multiple Lines of Coverage
Other
Remarks:
Please Read Privacy Policy Notice As of January 01, 2002:
In order to meet the requirements of the Gramm-Leach-Bliley Act we are providing you with this document, which notifies you of the privacy policies and practices of Baughman Ins., Inc. t/a Frank B. Hartzok Insurance Agency.
We collect non public personal information about you from the following sources:
Information we receive from you on quote forms and applications.
Information we receive from a consumer reporting agency.
Information we receive from motor vehicle reports.
Information we receive from CLUE reports.
We disclose non public personal information about our customers and former customers only as permitted by law. In some cases this may mean information can be disclosed without your authorization. Some examples of non affiliated parties with whom we may share non public personal information about you in the course of servicing your account are:
A lending institution from which you have or are obtaining a loan.
A leasing company with whom you have a lease agreement.
Claims adjusters, appraisers, and others with an interest in your claim.
Dealers from whom you have recently purchased or are purchasing an automobile, motorcycle, boat, recreational vehicle, etc.
Someone doing title or licensing paperwork for you such as a messenger service.
Inspection Stations
Insurance Companies from whom we are obtaining a quote.
An opt-out notice is not being included because one is not required under these circumstances.
We restrict access to non public personal information about you to employees of this agency. We maintain physical, electronic, and procedural safeguards to guard your non public personal information.
Since we share your information only as allowed by law, you do not need to take any action at this time concerning the privacy notice. We trust you will find this explanation to be helpful and hope that you find comfort with the fact that we limit who we share your information with and that we do not sell your information to third parties. If we can provide further information or be of further assistance please call us at (717)264-6113.