OPT-IN FORM FOR TEXT MESSAGING

The undersigned client “You” consents to receive text messages from Interlock Financial Services, LLC or others acting on the Agency’s behalf. As part of this consent, you represent and warrant the following:

(1) You understand that no coverage may be amended via text message.

(2) The Agency or others acting on the Agency’s behalf may send text messages in various formats and with various contents, including but not limited to, text messages about insurance policies and other transactions initiated by You or marketing the products and services offered by or through the Agency.

(3) You are the owner or authorized user of the mobile phone number identified below. You will notify us immediately if you are no longer the owner or authorized user of the mobile phone number identified below.

(4) You are solely responsible for any message and data charges associated with such text messages.

(5) The Agency has made its Text Messaging Terms and Conditions (“Terms and Conditions”) available to you on its website, and will provide you with a hard copy of the Terms and Conditions upon request. By submitting this opt-in form, you agree to the Terms and Conditions.

(6) If you submit this opt-in form, you will receive text messages to the mobile phone number entered in the form.

If you do not wish to receive text messages from the Agency or others acting on the Agency’s behalf, or do not agree to the Terms and Conditions, you should not submit this form.

NPN 14019536

GA 2638023 | OH 1195347 | MD 3000324459

TX 2307516 | MI 14019536

NAICS Code 524210

D-U-N-S Number 087268292

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