New York Fair Credit Pre-Notification

As part of our underwriting procedure, an investigative consumers report may be prepared. Information may be obtained through a credit report. If any investigation is made, you can be sure that it will be handled in the strictest of confidence.

If you want to know of a report has been ordered, or if you would like information on the nature and scope of the Consumer Report, call one (800) 645-1938. National Disclosure Center, P.O. Box 390, Springfield, PA 19064-0390 or send a written request for this information.

The New York Fair Credit Reporting Act requires your signed and dated authorization to procure this type of report. Please sign below and return one copy to our office. Please keep a second copy for your records. We will reveal no information contained in this report, to persons outside our company or the insurance company, which we place or have your insurance quoted from and we assure you that all information will be kept confidential.

You have my permission to obtain an investigative and DMV report on me. I have retained a copy of this form for my records