Privacy Policy

Privacy Policy Notice (as of 7/1/01) Under the Gramm Leach Bliley Act, the Sheets-Forrest-Draper Insurance Agency is required by law to provide notice of its privacy policies and practices to it's customers. This new law affects the entire financial services industry which includes insurance companies and insurance agencies. Our Privacy Policies and Practices are as follows:

1. INFORMATION WE COLLECT: We collect non-public personal information about you from the following sources: *Information we receive from you on applications or other forms. *Information about your transactions with us or our affiliates. *Information we receive from a consumer reporting agency. *Information we receive from you from our web site.

2. INFORMATION WE MAY DISCLOSE TO THIRD PARTIES: We may disclose all the information we collect about you to a third party if the disclosure will enable that party to perform a business, professional, or insurance function for us.

3. NONAFFILIATED THIRD PARTIES TO WHOM DISCLOSURES MAY BE MADE: We do not disclose any non-public information about you to non-affiliated third parties, except as permitted by law.

4. OUR PRACTICES REGARDING INFORMATION CONFIDENTIALITY AND SECURITY: We restrict access to non-public personal information about you to those employees who need to know that information in order to provide products or services to you. We maintain safeguards that comply with federal regulations to guard your information.

5. OUR POLICY REGARDING DISPUTE RESOLUTION: Any controversy or claim arising out of or relating to our privacy policy, or the breach thereof, shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof.

6. RESERVATION OF THE RIGHT TO DISCLOSE INFORMATION IN UNFORESEEN CIRCUMSTANCES: In connection with the potential sale or transfer of its interests, the Sheets-Forrest-Draper Insurance Agency, reserves the right to transfer your information to a third party entity that 1) concentrates its business in a similar practices or services 2) agrees to be Sheets-Forrest-Draper Ins. Agency's successor in interest with regard to the maintenance and protection of the information collected and 3) agrees to the obligations of this privacy statement.

Below is our Opt Out Form. It combines the Gramm-Leach Bliley Act and the Fair Credit Reporting Act opt out rights and requirements on one convenient form. It is very important that you be aware, that if you choose to opt out, it will negatively impact our ability to be of complete service to you. We would not only have limited options on securing an insurance product for you, but also not be able to obtain competitive premium quotations for you with other Companies we represent at the time of your renewal or a policy change you request. This Privacy Notice and Opt-Out Form is being provided to you as required by law. It does not imply that your non-public personal information has been or would be utilized in any way by us other than to provide you with insurance products and service which has been our business for One Hundred Years. Feel free to call our office if you have any questions or concerns with our Privacy Notice.

Please read the text below and decide whether you wish to exercise your right to opt out of the information sharing described.

If you choose to exercise your to opt out, you must mail this form back to us at P.O. Box 218, Marion Iowa 52302. Your response must be postmarked no later than 30 days from the date you received this notice from us in person in order for it to be valid. If you do not mail this form back or do not mail it back within 30 days, you have not exercised your opt out right, and we can share the information described.

_____ I wish to exercise my right under the Gramm-Leach-Bliley Act to opt out of Sheets-Forrest-Draper's sharing nonpublic personal information about me to non-affiliated third parties for purposes other than those that are permitted by law.

___________________________ Customer Printed Name

___________________________ Customer Signature/Date