Electronic Delivery

Consent for Electronic Delivery of Insurance Policies

If you would like to participate in our electronic delivery program, please review the following statement, provide us with your contact/recipient e-mail address and fax number, sign and return to us via e-mail or fax.
Name(Required)
We, (business name)
("Client") hereby give consent and agree to receive documents related to insurance coverages written through or quoted by Walsh Duffield Companies, Inc. (“Agent”) in the form of electronic records. Agent may transmit documents to Client through electronic media, including but not limited to electronic mail, optical disks (including but not limited to compact disks and digital versatile disks), floppy disks, hard drives, thumb drives, jump drives, magnetic tapes, facsimiles, downloads from Web sites, and any other kinds of electronic media acceptable to both Client and Agent. Documents to be so delivered include but are not limited to policy information pages and coverage forms; endorsements; binders; certificates and evidences of insurance; automobile insurance identification cards; premium quotations; premium worksheets; invoices, premium finance agreements; audit statements; loss control reports; claim reports; correspondence; and notices of cancellation and non-renewal. Client’s signature or that of Client’s representative signifies that Client voluntarily agrees to use electronic records in accordance with section 309 of the New York State Technology Law. Client understands that from the date of this agreement until such time as Client or Client’s representative revokes this consent in writing, Agent will send documents to Client in electronic form only and will not provide Client with paper copies of the documents.(Required)
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