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Consent Form for Phone Calls and Text Messages

 

Guimaraes Insurance Agency, LLC

Effective Date: 01/21/2025

 

This consent form authorizes Guimaraes Insurance Agency, LLC and its representatives to contact you via phone calls and text messages at the phone number you provide below.

Communications will include, but are not limited to, insurance quotes, policy updates, renewal reminders, promotional offers, marketing purposes, insurance reviews, and other insurance-related information.

 

I consent to receive recurring communications, including automated and manual phone calls and text messages, from Guimaraes Insurance Agency, LLC at the phone number listed below.

 

I agree to consent the company, their representatives, and parties calling on their behalf, to contact me at the number provided below through the use of automated technology, using an automated telephone dialing system, SMS/MMS message, AI generative voice, and prerecorded and/or artificial voice messages even if my number(s) is/are listed on a national, state, or business do-not-call registry.

 

I may revoke this consent at any time by replying “STOP” to any text message or by contacting us at 508-823-1234. Opt-out requests will be processed within 10 business days.

 

My consent is not a condition for purchasing insurance coverage or any other services from Guimaraes Insurance Agency, LLC.

 

You may receive recurring messages related to your insurance needs. Message and data rates may apply based on your mobile carrier’s plan.

 

We value your privacy. Your information will be handled securely and in accordance with our Privacy Policy, which you can view here: https://www.rafga.com/privacy-policy

 

Customer Name: ___________________________

Phone Number: ___________________________

Date: ___________________________

 

By signing below with ESIGN signature, I am providing Prior Express Written Consent and confirm that I have read and understood this consent form.

 

I authorize Guimaraes Insurance Agency, LLC to contact me via phone calls and text messages for the purposes outlined above.

Signature: ___________________________

Printed Name: ___________________________

Date Signed: ___________________________

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