Effective Date: [MONTH DAY, YEAR]
These Terms of Service (“Terms”) govern your use of this form, scheduling page, related communications, and any associated information-request pages operated on behalf of [AGENT FULL LEGAL NAME], Licensed Life Insurance Agent (“we,” “us,” or “our”).
By submitting a form, requesting information, scheduling an appointment, or otherwise communicating with us, you acknowledge these Terms and our Privacy Policy.
This form is provided so that consumers may:
Request information regarding life insurance products.
Request contact from a licensed life insurance agent.
Schedule or request an appointment.
Receive follow-up relating to their inquiry.
This form is not an insurance application and does not provide, approve, bind, or guarantee insurance coverage.
Insurance-related activities requiring a license are conducted only by appropriately licensed and appointed insurance professionals.
Agent Name: [AGENT FULL LEGAL NAME]
License Type: Licensed Life Insurance Agent
License Number or NPN: [LICENSE NUMBER OR NPN]
Licensed State(s): [LIST APPLICABLE STATES]
Administrative personnel and automated systems may assist with scheduling, reminders, communications, recordkeeping, and follow-up management. They do not approve insurance applications, bind coverage, issue policies, or provide licensed insurance recommendations unless appropriately licensed and authorized.
By submitting this form, you acknowledge that:
You are requesting information or contact regarding life insurance.
You are not submitting a formal insurance application through this inquiry form.
You are not guaranteed eligibility for coverage.
You are not guaranteed any premium, policy term, benefit amount, or underwriting outcome.
No insurance coverage becomes effective by submitting this form.
You are not obligated to purchase an insurance product.
Any insurance product is subject to applicable licensing requirements, product availability, carrier requirements, completion of any required application, underwriting review where applicable, policy terms, carrier approval, and payment of required premiums.
You agree to provide accurate information when completing this form or communicating with us.
Do not submit Social Security numbers, payment-card information, bank account information, detailed medical records, prescription histories, or complete underwriting information through this initial inquiry form unless you are directed to an appropriate authorized process.
By providing your telephone number and submitting a request for information or an appointment, you authorize [AGENT FULL LEGAL NAME] and authorized administrative representatives acting on the agent’s behalf to contact you by telephone regarding:
Your request for life insurance information.
Appointment scheduling, confirmation, reminders, rescheduling, or cancellation.
Follow-up concerning your inquiry.
Customer-service matters related to your request.
Your submission does not require you to purchase any product or service.
This authorization does not constitute consent to artificial-voice, prerecorded-voice, or automated marketing calls unless you separately provide any consent required by applicable law.
Where required consent has been obtained and applicable law permits, telephone calls may be recorded, transcribed, or analyzed using automated tools, including artificial intelligence.
Such tools may assist with:
Identifying appointment requests or appointment outcomes.
Managing follow-up activities.
Producing internal summaries, notes, tags, or tasks.
Supporting customer service, quality assurance, training, and business recordkeeping.
Automated tools do not determine your eligibility for life insurance, approve an application, bind insurance coverage, issue a policy, or replace the role of a licensed insurance professional or applicable insurance carrier.
You may decline to participate in a recorded or transcribed call. Where required by law, your permission will be requested before recording or transcription occurs.
By checking the separate SMS consent checkbox on the form or otherwise separately consenting to receive text messages, you agree to receive text messages from [AGENT FULL LEGAL NAME] or authorized administrative representatives acting on the agent’s behalf.
Text messages may relate to:
Your request for life insurance information.
Appointment scheduling, confirmation, reminders, rescheduling, or cancellation.
Follow-up concerning your inquiry.
Customer-service matters related to your request.
Message frequency may vary depending on your inquiry, appointment activity, and communications with us.
Message and data rates may apply according to your mobile carrier plan.
You may opt out of text messages at any time by replying STOP to any text message received from us. After opting out, you may receive a final message confirming that your opt-out request has been processed.
For assistance, reply HELP to a text message or contact us at:
Email: [BUSINESS EMAIL ADDRESS]
Phone: [BUSINESS PHONE NUMBER]
After opting out, you may request to receive text messages again by submitting a new request with SMS consent or otherwise providing new consent to receive text messages.
Mobile carriers are not liable for delayed or undelivered messages.
Your consent to receive text messages is not a condition of purchasing any insurance product or service.
Our collection and use of information relating to text messages is described in our Privacy Policy:
Privacy Policy: [INSERT PUBLIC PRIVACY POLICY PAGE LINK]
By providing your email address and requesting information or an appointment, you authorize us to send emails concerning your inquiry, requested information, appointment scheduling, appointment reminders, follow-up regarding your request, and related customer-service matters.
Promotional or marketing emails, where sent, will provide an appropriate method to opt out of future promotional emails. You may also request to stop promotional emails by contacting us at [BUSINESS EMAIL ADDRESS].
Opting out of promotional emails does not prevent communications that are reasonably necessary to respond to an active request, manage an appointment, or provide customer service.
Any insurance information provided on a form, landing page, in an email, text message, phone call, or preliminary discussion is general information only unless and until confirmed through appropriate licensed-agent and carrier-approved processes.
Actual insurance benefits, exclusions, limitations, premiums, underwriting requirements, availability, and policy terms are governed by applicable official insurance-carrier documentation and any issued policy.
Information provided through this form or related preliminary communications is not legal, tax, investment, estate-planning, or financial advice.
You should consult appropriate qualified professionals regarding legal, tax, investment, estate-planning, or other professional matters relating to your personal circumstances.
Our Privacy Policy explains how personal information is collected, used, stored, and protected.
Privacy Policy: [INSERT PUBLIC PRIVACY POLICY PAGE LINK]
By submitting this form or otherwise communicating with us, you acknowledge that the Privacy Policy has been made available to you.
You agree not to use this form or related pages to:
Submit false, misleading, fraudulent, or impersonated information.
Provide another person’s contact information without authorization.
Interfere with the operation or security of the form or related systems.
Submit unlawful, abusive, threatening, or malicious content.
Attempt unauthorized access to information or systems.
We may disregard, restrict, or remove submissions that appear fraudulent, abusive, unlawful, or unrelated to the intended purpose of this form.
We make reasonable efforts to maintain accurate and functional forms and communication processes. However, we do not guarantee that forms, scheduling tools, pages, or communications will always be uninterrupted, error-free, or continuously available.
Nothing in these Terms limits rights that cannot legally be limited under applicable insurance, privacy, telecommunications, or consumer-protection laws.
To the extent permitted by applicable law, [AGENT FULL LEGAL NAME] will not be liable for indirect, incidental, special, consequential, exemplary, or punitive damages arising from use of this inquiry form, scheduling process, or preliminary communications.
This limitation does not apply where liability cannot legally be limited or excluded.
We may update these Terms from time to time. Updated Terms will be posted with a revised Effective Date.
These Terms are governed by the laws of the State of [STATE WHERE AGENT IS BASED], except where the laws of another jurisdiction apply and cannot legally be waived.
Questions about these Terms may be directed to:
[AGENT FULL LEGAL NAME], Licensed Life Insurance Agent
License Number or NPN: [LICENSE NUMBER OR NPN]
Email: [BUSINESS EMAIL ADDRESS]
Phone: [BUSINESS PHONE NUMBER]
Mailing Address: [BUSINESS MAILING ADDRESS]