Texans Insurance
& Financial Group
101 Southwestern Blvd.
Suite 230
Sugar Land, Texas 77478
Fort Bend County, TX
Office: (281) 277-7800
Toll Free: (800) 747-6140
Fax: (281) 277-7801

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Sugar Land, Texas Insurance Agency
& FINANCIAL GROUP
TEXANS INSURANCE
Your Sugar Land, Texas Trusted Agent Since 1991
Texas Home - Auto - Health - Business Insurance
Texans Insurance & Financial Group, Inc.
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Texans Insurance & Financial Group, Inc
Opt Out Form
January 01, 2006
Please read the text below and decide whether you wish to exercise your
right to opt out of the information sharing described, If you choose to
exercise your right to opt out, you must mail this form back to us at:

Texans Insurance & Financial Group, Inc
101 Southwestern Blvd Suite 230
Sugar Land, TX 77478

If you do not return this form you have not exercised your opt out right, and
we can share the information described. Any policyholder may opt out on
behalf of other joint policyholders. An opt out by any joint policyholder will be
deemed to be an opt out by all policyholders of the policy issued by the
affiliated Insurance Carriers of this agency.

[ ] I wish to exercise my right under the Gramm-Leach-Bliley Act to opt
out of Texans Insurance & Financial Group, Inc's sharing nonpublic
personal information about me to non-affiliated third parties for purposes
other than those that are permitted by law.
[ ] I wish to exercise my right under the Fair Credit Reporting Act to opt
out of Texans Insurance & Financial Group, Inc's sharing nontransactional
information about me to affiliates.
Customer Signature
Date
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