Text Authorization

Name……………………………………………………………………….. Address…………………………………………………………………….. ……………………………………………………………………………… Date of Birth………………………………………………………………... Mobile Telephone Number…………………………………………………. I consent to M D Farmer enterprises, Inc and its affiliates including Missy Farmer Insurance Agency to send sms messages to my mobile telephone number. I will contact them to amend consent if necessary. Signature………………………………………………. Date…………………………………………………….

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