I authorize Cheep Insurance and/or its insurance company suppliers, on behalf of myself and other policyholders listed, to collect, use and disclose information or reports relevant to my personal insurance rating, policy placement and payment thereof. I understand that as an insurance broker, Cheep Insurance is gathering this consent on behalf of multiple insurance companies for the purpose of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or changes and preventing fraud. I authorize collection, use and disclosure of relevant personal insurance reports including policy and claims history of up to 25 years, investigative, rating and risk information and personal credit information, as permitted by law and in accordance with privacy policies.

For the purposes of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or change in coverage and payment thereof, I authorize Cheep Insurance and/or its insurance suppliers, on behalf of myself and other applicants/policyholders listed to collect, use and disclose personal information, including relevant reports containing policy and claim history up to 25 years, for the purposes of assessing, managing and underwriting risk, determining a premium, establishing eligibility for a premium payment plan (as applicable), investigating and settling claims, analyzing business results, detecting and preventing fraud as permitted by law and in accordance with its privacy policies. I understand that Cheep Insurance is gathering this consent on behalf of multiple insurance companies and that I can withdraw my consent at any time.