This is to notify you that in connection with your application, our carrier partners may procure a consumer report on you as part of the process of considering your application or determining whether you meet its contracting standards. In the event that information from the report is utilized in whole or in part in making an adverse decision, before making the adverse decision, our carrier partners will provide you with a copy of the consumer report and a description in writing of your rights under the Fair Credit Reporting Act (FCRA). Please be advised our carrier partners may also obtain an investigative consumer report including information as to your character, general reputation, personal characteristics and mode of living. This information may be obtained by contacting various sources, including but not limited to, your present and previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that our carrier partners make a complete and accurate disclosure of the nature and scope of the information requested, and provide you with a summary of your rights under FCRA.
By signing your proposal for new or renewal insurance you are authorizing our carrier partners to obtain such reports and acknowledge that this authorization shall remain valid and in effect for the duration of your contract, initial application or subsequent applications with our carrier partners, their affiliates and/or their subsidiaries. Our carrier partners reserve the right to run subsequent consumer reports and/or investigative consumer reports about you, as our carrier partners, in their sole discretion, determines is necessary.
You may revoke this Authorization at any time, provided that the revocation is in writing, except to the extent that our carrier partners have taken actions relying on this Authorization. If you would like to revoke this Authorization, please send a written revocation to our office via email at email@example.com or via mail to 8670 W. Cheyenne Ave., Ste 120, Las Vegas, NV 89129 and will direct it to the appropriate carrier partner for you.
By signing your proposal for new or renewal insurance, you authorize our carrier partners and their affiliates to obtain a consumer report and/or an investigative consumer report about you in order to process your insurance application. In addition, you also authorize all entities having information about you, including present and former employers, criminal justice agencies, departments of motor vehicles, schools and credit reporting agencies, to release such information to our carrier partners and their affiliates.
Blue Lotus Insurance Brokers, Inc.
8670 West Cheyenne Avenue
Las Vegas, NV 89129
7251 West Lake Mead
Las Vegas, NV 89128
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