Kellerman Insurance, Inc.
101 W 4th St., PO Box 1025
Holton, KS 66436
785-364-2921/800-366-2922
kellermaninsurance.com
We value you as a customer and take your personal privacy seriously.
However, Kansas law now requires that we notify you in writing about our
agency’s privacy policy. Please take a moment to look over our policy and
let us know if you have any questions about this.
We do not disclose any nonpublic personal information about our
customers or former customers, except as necessary to provide insurance
and financial products or services to them. In order to obtain the products
and services you need, we collect information about you from the following
sources:
• Information we receive from you on applications and other forms
• Information about your transactions with us or our affiliates and
• Information we receive from a consumer reporting agency
• Information we receive from the companies we represent that
provide insurance policies to you.
• Information from other sources such as employers or government
agencies
EXAMPLES of such information may include your name, address, social
security number, credit scores, policy coverages and limits, premiums,
income, claims and beneficiaries.
As independent agents, we disclose the information described above on
your behalf to insurance companies and other non-affiliated third parties. (A
non-affiliated third party could be a company we do not currently write your
policy with.) We do occasionally shop your insurance with other
companies we represent to make sure you are getting the most
competitive coverage and cost. Additional reasons we do this may be
your risk has changed, the preference of risks written by your current
insurer may have changed or we have new markets available. Again,
this is necessary to provide the competitive coverage and cost you expect
from us. We do not sell your customer information.
We restrict access to personal information about you to those employees
who need to know that information to provide insurance products or
services to you. We maintain physical, electronic and procedural
safeguards that comply with federal regulations to guard your nonpublic
personal information.
If you require more privacy protection than what we provide, you may
exercise your right to “opt out” of the information sharing described.
By opting out we cannot automatically shop our other markets for you. You
must mail this notice back to us within 30 days from when you receive it if
you chose the “opt out” option. If you do not mail this notice back to us,
you have not exercised your “opt out” right and we will presume that our
privacy policy is satisfactory to you.
Complete and return only if you choose the “Opt out provisions”
______ I wish to exercise my right under Kansas law to opt out of the
Agency’s sharing nonpublic personal information about me to
Insurance companies and other non-affiliated third parties
(except as required or permitted by law). This means I should
be contacted if the agency wants to shop my insurance with the
other companies.
_______ I wish to exercise my right under the Fair Credit Reporting Act
to opt out of the agency’s sharing nontransactional information
about me to affiliates.
________________________ ______________________
Customer Signature Date
_________________________
Name (printed)
_________________________ _______________________
Address City, State, Zip
To Opt out return to : Kellerman Insurance, Inc.
PO Box 1025, Holton, KS 66436