Contract Authorization for Electronic Communication
{name-1-first-name} {name-1-last-name} I hereby agree to and do hereby authorize SG to communicate electronically, including sending and receiving text messages from and to my cell phone in lieu of or in addition to phone calls in order to convey insurance policy information, including time sensitive notifications. I understand that text messaging rates may apply to all messages received from and sent to SG. I also understand that I or SG may revoke this authorization in writing at any time. I agree to secure my phone at all times and to hold SG harmless for any electronic messaging charges or fees generated by this service. I further agree that in the event my contact/cell phone number changes that I will inform SG or be liable for any fees or charges incurred. This authorization will remain in effect for the duration of my insurance policy term with SG, unless revoked earlier in writing by me or SG.
{name-1-first-name} {name-1-last-name} I hereby authorize SG to charge the indicated credit card for the amount indicated above. As I am using a credit card to settle this transaction, I understand and agree to pay a non-refundable Credit Card Convenience Fee “CCCF” not to exceed 3.25% of this transaction and all other subsequent transactions. Accordingly, I acknowledge and therefore agree that the services represented by the CCCF were fully earned and provided thus the amount charged is fully and completely earned and that no cancellation is applicable to this transaction and; that refunds of this transaction, including the CCCF DO NOT apply.
Name Change Request and Non-Refundable Charges
{name-1-first-name} {name-1-last-name} I hereby acknowledge I am applying for a Business or Other Name Change under each “authority” I am currently servicing and those I will service in the future. SG may process my Name Change request, however, IT IS EXPRESSLY UNDERSTOOD THAT I and I alone am responsible for and have the non-delegable duty to notify my insurance agent to update each of my fillings regarding this change, and all future name changes.
{name-1-first-name} {name-1-last-name} I hereby acknowledge that Plates, Tags, DOT Stickers and Registration charges are NOT REFUNDABLE. In the instance I request such a service, then cancel the service prior to its completion, I may be entitled to a refund from the State I am serving. However, the SG Fees for any such transactions are not refundable under any circumstance. This means there will be no credit card charge back, refund, credit to my account or refund of any sort otherwise because the SG service fees are considered fully earned.
{name-1-first-name} {name-1-last-name} I hereby acknowledge that in any instance a Charge Back is properly permitted, it will exclude the portion or fee, charged by the credit card processing company. Should I attempt a charge back on the non-refundable portion of any service fee from SG, I understand and agree that the attempt shall be invalidated or otherwise denied. The charge back fee of $50 [or an amount equal to the fee charged by the credit card processing company not to exceed $100] is due, will be due, is owed and payable by me to SG and shall be charged against my account and collected via my current payment method.
Informed consent & Mediation Agreement
Customer and SG [the Parties] agree that in the case of any claim or dispute related to this agreement, or any other matters, disputes, or claims between the Parties, it is agreed before filling any form of complaint or litigation, the Parties shall first attempt to resolve the matter using the process of mediation at the expense of Saint George Insurance Brokerage, Inc. The mediation process will be conducted by Los Angeles County Consumer & Business Affairs Mediation Services (http://dcba.lacounty.gov - 800.593.8222), an impartial neutral entity, according to commonly accepted practices. Both Parties understand that the nature of the mediation process is that they do not waive any legal rights by agreeing to mediate – however, if a mutually agreeable resolution is reached and agreed upon in mediation, the Parties may at their option sign a mutually agreeable, binding, enforceable agreement which resolves the issues and waives any further claims.
Saint George Insurance Brokerage Inc. [hereinafter SG] will process your mileage reports according to the information presented by you at the time you enter into the "service contract" with SG. If you incorrectly reported mileage to SG, we will correct it, if allowed. You may have to pay penalties as a result of the mistake. However, If you correctly reported mileage to SG but we reported them incorrectly, SG will correct the error, if allowed, and will pay the resulting penalty from our mistake. BE ADVISED, SG WILL NOT PAY MILEAGE FEES LEGALLY OWED BY YOU TO ANY ENTITY, AS OUR SERVICE IS TO REPORT THE MILEAGE AND NOT TO REDUCE ANY FEES OWED TO ANY ENTITY FOR ANY REASON. Your IRP Payment is not proof of renewal. Renewal is pending final approval from the DMV. You agree to hold SG harmless from any such fines, penalties or any other issues that may arise from or through the IRP process. SG IS NOT RESPONSIBLE FOR ADDITIONAL DMV CHARGES DUE TO MISTAKES OR INTERNET FAILURES. SG is not responsible or liable for any late penalty fees or suspension of permits due to late submission of required information. Paperwork received after the 15th day of the period's reporting due date is considered late.
06/09/2026
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