Quote Requests
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Options
If you wish to “opt out” of information sharing at Smathers Insurance, please complete this form and mail to:
Smathers Insurance
400 Main Street
PO Box 165
Clarion, PA 16214
I choose to limit Smathers Insurance from sharing my personal information for marketing purposes.
Please check the box(s) to select your preference(s):
I do not want Smathers Insurance Company to share information about me with other Smathers Insurance affiliates in order for the affiliates to market their products to me.
I do not want Smathers Insurance to share information about me with companies with whom it has a joint marketing arrangement in order for those companies to market their products to me.
In order to record your request properly, you must provide the following information (please print):
Name: _________________________________________________________________________________
First Middle Initial Last
Date of Birth: _________________ Last four digits of your social security number: ____________
Current Address: _____________________________________________________________________
Street Address Apt # PO Box #
______________________________________________________________________
City State Zip Code
_______________________________________________________________________
E-mail address (optional)
Account/Policy Number(s):
_______________________________________________________________________________________
_______________________________________________________________________________________