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I provide my express consent to the following: (1) That I may be contacted by or on behalf of Cornerstone Broker Insurance Services Agency, Inc., or its affiliates and subsidiaries, via e-mails, SMS, phone calls and prerecorded messages at any phone number(s) that I provide, even if the number is a wireless number or on any federal or state do-not-call list; (2) That such entities may contact me utilizing automated technology; and (3) That I am not required to submit this form, and thereby agree to all terms located herein, as a condition to receive any property, goods, or services that may be offered, and that I may revoke my consent at any time.
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