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Customer Testimonial Release Form

I authorize Simpson Financial Group, Inc. (“Simpson Financial Group”) to publish the attached testimonial in any of Simpson Financial Group’s marketing materials, including, but not limited to, its websites, press releases and videos.

I understand that only my first name, age and city will be disclosed with my testimonial in these marketing materials - my full name and address will not be disclosed.

I understand that I will not receive any monetary compensation for providing my testimonial.

I understand that Simpson Financial Group has the sole right to decide whether to use, or not to use, my testimonial and may summarize or shorten it as needed.

I am at least 18 years of age and can contract in my own name. I have read this release before signing it below and I fully understand the contents, meaning and impact of this release.

I acknowledge that I may revoke this consent by sending a written notice to Simpson Financial Group, Inc. at the address provided below and that my testimonial will be removed from all marketing materials and uses as soon as possible following Simpson Financial Group's receipt of my notice. I acknowledge that it may be difficult or impossible to remove it from all sources.

Simpson Financial Group, Inc.
Attention: Brand Management
One Boston Place
Suite 2600
Boston, MA 02108

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We are very interested in hearing from you about your insurance buying experience. Please provide your comments on one or all of the areas listed below.
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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289 Elm St
Suite 102
Marlborough, MA 01752

(978) 222-3939
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Attention: This website is operated by Simpson Financial Group, Inc. and is not the Health Insurance Marketplace website. In offering this website, Simpson Financial Group, Inc. is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at

Simpson Financial Group, Inc., which has licensed insurance agents in 50 states. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer's enrollment in a health plan. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled.