Thank you for filling out
this form COMPLETELY!
We value your input as PRIVATE
information. Every step has been
taken to insure your privacy,
security, and our intent is to
release quote information only
to you. We will not give your
data to ANY other person or
group for sales, marketing, or
ANY other purposes. By checking
the box below you agree to allow
Basic West Insurance Agency to
release this information via the
method you have chosen, and to
release them from any liability
should this information be
accidentally viewed by others.
Our intention is to maintain
your complete privacy.
|