Marketability Form

We accepted your implied consent in providing us with personal information, as without this information, we are unable to provide you with a quote or to meet your insurance needs. However, if you would like to restrict our use of your information, please check the box below and complete the following information.

Do not send any promotional or marketing material to me or otherwise contact me for marketing purposes other than as required for completion of an insurance quotation or purchase.

To limit the use of any of your personal information that we may have, please complete the following. Note: All fields on this form are mandatory.

First Name:
Last Name:
Address:
Policy Number:

Please click Submit below to forward this form to SmartCoverage Insurance.

Marketability Form

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