Innovative Insurance Agencies - Do Not Contact Registration Form

Do Not Contact Registration

The information you submit on this form will only be used to stop unwanted direct marketing offers through Innovative Insurance Agencies Do Not Contact Service. Your name will be added to this list, if you fill out this form in its entirety.

I understand...

	·	it will take approximately 6 weeks to take effect;
	·	all Innovative Associates will remove my name from their new-contact marketing lists;
	·	my name will be retained on the deletion service for three years;
	·	this service cannot stop flyers and other unaddressed advertising mail.

Please register me for the
		Do Not Mail Service
		Do Not Call Service
		Do Not Fax Service
		All

Mr. Mrs. Ms Miss
First Name		Last Name
Address 1		Address 2
City		Province / State
Postal Code / Zip		(eg: M3M3M3)
Phone	- -	Fax	- -
Company Name
Check here if person is deceased...

Spelling variations of name used on mailing labels
First Name		Last Name
First Name		Last Name
First Name		Last Name