By completing this form, you are requesting a licensed insurance sales agent to contact you by telephone/cell phone, email, and/or sms messaging to provide additional information about products and services. Your consent is voluntary and allows Better Place Insurance Group - Tavares and Kaitlyn Hampshire to contact you via text messaging, artificial or prerecorded voice messages, or automatic dialing for marketing purposes. You may contact us to change your preferences at any time. Changing your preferences will not affect your eligibility for any received benefits and enrollment, payment for coverage of services, or ability to get treatment. Data use charges and rates from your cellular carrier may apply.