Electronic Policy Consent Name* First Last My Email* Company Name*First and Last Name of Person to Receive Policies (if different than above) First Last Email of Person to Receive Policies (If different than above) Consent to Electronic Delivery* I consent to electronic policy delivery By checking this box, I specifically agree to receive any or all RogersGray Insurance policies via electronic delivery with the exception of those that RogersGray is legally obligated to send via mail.
