Text Messaging Permission Form

Fields marked with an * are required

Name *

Email *

I would like to OPT IN for text (SMS) message notification. This will allow Butler & Messier (BMI) to communicate via text messaging regarding my insurance coverage. *

I would like text (SMS) messages to be sent to my phone number: *

Phone Number *

I understand that message and data rates may apply. *

Participation in our text (SMS) messaging services is entirely voluntary. You have the right to refuse or withdraw your consent at any time. *

If I choose to OPT OUT of text (SMS) messaging, I will need to either text STOP, email info@butlerandmessier.com or call 401-728-3200. *

**Privacy Policy:** No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.