The undersigned does hereby authorize the release and delivery of all motor vehicle driving records relating to the undersigned, including but not limited to personal information, to my employer and its insurance agent, whose names and addresses are as follows:
Name and Address of Employer:
Buckley "The Tree Care Specialists"
1700 S Johnson Road
New Berlin, WI 53146
Name and Address of Insurance Agent:
American Advantage Insurance Group
Jon Oaks
2311 W Silvernail Rd
Pewaukee, WI 53072
This authorization shall continue in effect until revoked by the undersigned in a subsequent writing delivered to you.