Consent to collect, use, and disclose credit information

Should you provide Northbridge Insurance with consent to collect, use and disclose your credit information, we will use this information for assessing risk, providing you a quote, and determining your eligibility for a premium discount.  It will not impact your eligibility for insurance and will not be used as the only factor in determining your premium.  Your consent will be valid for as long as you have your insurance with us.  You have the right to withdraw your consent at any time, but by doing so, you may no longer be eligible for the best quote possible upon your next renewal.  You may indicate your consent by signing below.

If any other individuals in your household wish to provide their consent with respect to the collection and use of their credit information, they may do so by completing their own form.

We will safeguard your credit information in accordance with our privacy policy.  If you wish, you may learn more about our privacy policy at