AXL Insurance Group

AXL Insurance Group, Consent for Electronic Signature Disclosure

This consent contains important information you are entitled to receive before you consent to receive and execute Electronic Records.

If you consent, AXL INSURANCE GROUP, herein after referred to as the “Company, will transmit documents related to your application for Health & Life or Business Owners INSURANCE by electronic means, to the extent that the electronic transmission is consistent with applicable state and federal law. Any document the Company sends by electronic means, which complies with applicable law, will have the same force and effect as if that document was sent in paper format.

This consent will apply to the electronic transmission of your application for insurance and any supplemental forms, including delivery notices included in that transmission.

The Company will only send documents by electronic means if you consent by signing and return this form.  Your consent is voluntary. You are not required to consent to electronic transmission if you prefer not to do so. You have the right to receive the documents in paper form and you may be charged for paper copies. You can request paper copies of documents you receive by electronic transmission at any time by contacting the Company by one of the following methods shown on this form.

System Requirements

In order to successfully receive electronic transmissions, it is recommended that your electronic device supports Windows 8 and above
or mobile device with the following capabilities:
● An internet connection.
● An up-to-date version of any of the following internet browser software:
Google Chrome, Mozilla Firefox, Microsoft Edge, Safari.
● An active email address associated with an up-to-date version of an email
management service (e.g., Gmail, Yahoo Mail, Outlook).
● Adobe Acrobat or similar software for viewing and printing portable
document format (PDF) files

If you agree to the terms outlined above and want policy documents delivered electronically via email.  

Signature:

Title:   _____________________

___________________________
Date

AXL Insurance Group, Email: info@AXLinsurance.com Phone 703 459-7575