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1. I acknowledge and understand that neither nor Advisors Excel, LLC or any of their respective representatives are affiliated with Medicare, CMS or any government agencies.
2. I give my written consent for representatives of , , and/or Advisors Excel, LLC, 2950 SW McClure Rd, Topeka KS 66614 to contact me about Medicare via any of the contact information I have provided in this form.
3. I hereby request a Medicare quote. I acknowledge and understand that I will be contacted by a licensed insurance sales agent regarding the purchase of a Medicare Supplement policy and/or a Medicare Advantage plan.
4. Coverage purchased after initial enrollment period are subject to eligibility requirements. Guarantees are backed by the financial strength and claims-paying ability of the issuing insurer.
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6. By providing the information above, I grant permission for licensed insurance agent, , to call or email me regarding my Medicare options including Medicare Supplement, Medicare Advantage, and Prescription Drug Plans.