I understand that the J. Byrne Agency, Inc. on behalf of the Insurance Company will order an investigative consumer report as part of the underwriting process to qualify, evaluate, and quote my insurance coverage. Various consumer reports such as motor vehicle reports, credit reports, and claim history with prior insurance companies, may be obtained. In the event that the coverage is denied based on information in one of these reports, I will be advised of this and given the name and address of the consumer agency making the report. Please note: The price estimate (or quote for insurance coverage) provided to you by the J. Byrne Agency, Inc. will be base on the information supplied by you on this application.

I Have Read the "Fair Credit Statement - and I AGREE to the terms set forth.

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