Disclosure version: texting-page-2026-10-19
I authorize Klossner Valenta Insurance Agency to send customer-care SMS/MMS messages to the mobile number I provide about policy service, billing and renewal reminders, claim-status updates, and document or photo requests. Message frequency varies. Message and data rates may apply. Reply STOP to cancel or HELP for help. Mobile information will not be sold or shared with third parties or affiliates for marketing or promotional purposes. Consent is optional and is not required to buy or keep a policy.
Read the SMS Terms and Privacy Policy. You may instead give verbal permission to a staff member after hearing the disclosure. No text message or YES reply is required to authorize service texts.
Sign only if you choose to authorize SMS/MMS. An unsigned form does not grant permission.
Full name:
Mobile number:
Signature:
Date/time:
Staff receiving authorization:
Staff: retain the signed record and record the mobile number, source, date/time, employee and disclosure version in the texting system before sending.