Disclosures and Compliance
E-Sign Disclosures and Consent
ELECTRONIC SIGNATURES IN GLOBAL AND NATIONAL COMMERCE ACT (ESIGN) DISCLOSURE AND AGREEMENT
Please read this Electronic Signatures in Global and National Commerce Act (ESIGN) Disclosure and Agreement carefully and keep a copy for your records.
E-Sign Disclosure and Consent
We are required by law to provide you with certain information in writing regarding your relationship with us. The United States federal E-SIGN Act and certain state and other national laws allow us to provide information to you electronically, with your prior consent; we also require your general consent to use electronic records and signatures in our relationship with you (collectively “E-Sign Consent”). Therefore, before you execute your Application, Agreement and/or conduct your relationship with us, you must review, read, understand and consent to the terms outlined herein.
You understand that your signature is legally binding on you, whether electronic or signed on paper.
Please print a copy of this Consent for your records.
Electronic Signature and Electronic Delivery of Disclosures and Notices. By computer mouse-clicking “I agree…” and/or “I approve and accept…” and/or typing your name in a prescribed signature field on our Internet website application page(s), and/or providing your email address to us, you agree that we may provide you with any information related to your Agreement and/or Program participation and/or insurance/coverage policy with us in electronic format until you withdraw your consent, as described below. Your consent to receive electronic communications and transactions includes all of the forms and documents on or linked with this website or our other internet-website applications, which include but are not limited to:
- Applications and/or agreements for coverage and/or program participation
- ID cards,
- Policy and coverage contracts,
- Evidence of coverage,
- Descriptions of coverage,
- Confirmations of coverage,
- Certificates of insurance,
- Service and Coverage agreements, and
- Responses to communications from you.
By providing your consent, you are also confirming that you have the hardware and software described below, that you are able to receive and review electronic records, and that you have an active email account.
Your consent to use electronic signatures and documents applies only to forms and notices related to your Agreement with us and/or your request(s) for program participation and/or coverage through us.
Your consent does not include insurance policy cancellation or termination notices.
Paper Signature and Paper Delivery of Disclosures and Notices.
You have the right to receive a paper copy of the forms, notices and other communications described above. There is no cost to receive paper copies of any electronic records. If you wish to receive a paper copy of any of the forms listed above, please provide your name, mailing address, daytime telephone number, and the documents you wish to receive to one of the following:
- EMAIL: ClientService@GRTinsurance.com
- TOLL-FREE: (833) 878-5478
- MAIL: GRT Insurance Agency LLC, 6789 Quail Hill Pkwy., Suite 404, Irvine, CA 92603 USA
It is your responsibility to provide us with true, accurate and complete e-mail address, contact, and other information related to the Disclosure and your Account(s), and to maintain and update promptly any changes in this information. You can update information (such as your e-mail address) by contacting us at the addresses and phone numbers listed above.
Computer System Requirements.
In order to use electronic signatures and to receive electronic communications, you will need the following computer hardware and software:
- A computer with an Internet connection;
- An active e-mail address accessible and usable by you;
- A current web browser that includes 128-bit encryption with cookies enabled;
- Software that supports Internet Explorer, Safari, Chrome or Firefox and enables you to receive and view Portable Document Format (PDF) files, such as Adobe Acrobat Reader (available for free download at http://get.adobe.com/reader/); and
- Sufficient computer storage space to save past Communications and/or an installed printer to print them.
Updating your contact information. It is your responsibility to keep your primary email address up to date so that we can communicate with you electronically. You understand and agree that if we send you an electronic Communication but you do not receive it because your primary email address on file is incorrect, out of date, blocked by your service provider, or you are otherwise unable to receive electronic Communications, we will be deemed to have provided the Communication to you.
Please note that if you use a spam filter that blocks or re-routes emails from senders not listed in your email address book, you must add us to your email address book so that you will be able to receive the Communications we send to you.
You can update your primary email address or street address at any time by emailing your change request to ClientService@GRTinsurance.com; or mailing it to: GRT Insurance Agency LLC, 6789 Quail Hill Pkwy., Suite 404, Irvine, CA 92603 USA. If your email address becomes invalid such that electronic Communications sent to you by us are returned, we may deem your Account to be inactive, and you will not be able to transact any activity using your GRT Service System Account until we receive a valid, working primary email address from you.
Withdrawal of Electronic Acceptance of Disclosures and Notices.
You may withdraw your consent to receive electronic communications at any time. If you wish to do so, please notify us at ClientService@GRTinsurance.com, and provide your name, mailing address, daytime telephone number, and a description of the type of transaction from which you are withdrawing your consent. There are no conditions, consequences or fees to the withdrawal of your consent to receive electronic communications from us.
*Version of June 1, 2018
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