CONSENT AND AGREEMENT TO ELECTRONIC TRANSACTIONS / ELECTRONIC SIGNATURE
You consent to conduct transactions in electronic form. This can include the use of electronic communications, electronic postings, electronic records, electronic signatures for the communications, and electronic notices and disclosures described below.
You also acknowledge that:
•You can access and read this Consent and Agreement to use Electronic Signature and Electronic Delivery of Information.
•You can print this Consent and Agreement.
•Your electronic signature is the legal equivalent of your written signature, just as if you had signed a paper document.
You are not obligated to enter into transactions electronically and may conduct insurance transactions in paper format instead.
It is your responsibility to provide us with an accurate email address as well as other contact information. It is also your responsibility to inform us of any changes in this information.
If you choose to conduct insurance transactions in paper form, withdraw your consent to electronic transactions, or if would like to update your contact information or get a copy of your policy or other notices in paper or another nonelectronic form, please contact the Company. You can call us toll-free at 1-855-434-3744 or write to CUMIS Insurance Society, Satellite Office at 34 Schroeder Court, Suite 330, Madison, WI 53711. There is no fee charged for such requests.
You agree that your electronic signature authorizes the Company to do the following:
•Electronically process this insurance transaction and any future transactions that may be needed to administer and help keep your coverage in force under the insurance policy.
•Communicate with you by mail, telephone or email.
You consent to use electronic communications, electronic postings, electronic records and electronic signatures rather than paper documents for:
•agreements and contracts, including this Consent and Agreement.
•notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you.
•notices, documents, statements, data, records or communications regarding your coverage, including changes in terms of coverage.
•privacy policies and notices.
•periodic billing or account statements.
You understand and agree that this election provides consent to the Company to deliver your policy, any endorsements and all notices electronically, including notice of nonrenewal and notice of cancellation. To ensure uninterrupted communication, please be sure to update the email address you provided to the Company in the event this email address should change.
You understand and agree that in order to access the documents we send to you electronically, a minimum standard of technology is required. The fully functional hardware, software and services necessary include a modern computer or mobile device, Internet access, a working email address and email software, and modern, compatible web-browsing software. You understand that you will be deemed to have received the foregoing documents even if you fail to provide the necessary technology.
PREAUTHORIZED PAYMENT AUTHORIZATION
You authorize the Company to retain your account information and deduct premiums from your checking or savings account or charge your credit card for the coverage as you have instructed.
CUMIS Insurance Society, Inc.
Home Office Address: 200 Heritage Way, Waverly, IA 50677
Satellite Administrative Office Address: 34 Schroeder Court, Suite 330, Madison, WI 53711