We represent many companies and will quote the product with the most competitive company for your individual situation. These policies cover payments not covered by Medicare such as deductibles and copayments. There are ten different levels of coverage defined by a letter code system, "A" being the least coverage while "J" is the most. Not all companies sell all letters but an "A" with one company has the same coverage as an "A" with a different company. You DO NOT need more that one Medicare Supplement policy. NOTE THAT YOU MUST COME INTO OUR OFFICE AT 215 W. WASHINGTON ST., MARQUETTE MICHIGAN TO PURCHASE ANY PRODUCT QUOTED!

1. Email address for the return quote and zip code? Enter like yourname@aol.com 49855.

2. Birthdate & Sex? If Husband & Wife (H:01/01/70, W:01/01/70) list as shown.

3. Do you qualify for a nonsmoker credit? (H:Y, W:N)

4. Is anyone being quoted taking any medication, if so what is it and what is the dosage? (H:Y, W:N)

5. Has anyone being quoted been hospitolized in the last 3 years? If YES, duration and for what. (H:Y, W:N)

6. Type of Product being requested?

A
C
F

G

5. If you have a Medicare Supp., what company and product? (H:Y-Medico, W:N)

6. What payment plan would you like quoted?
Annual
Semiannual
Quarterly
Monthly
Multiple items may be chosen.

7. If you would like to receive a free Guide to Health Insurance for People with Medicare fill in your name and address below.

NOTE THAT THIS INSURANCE CANNOT BE PURCHASED OVER THE INTERNET OR PHONE. YOU MUST COME INTO OUR OFFICE AT 215 W. WASHINGTON ST., MARQUETTE MICHIGAN TO BUY THE QUOTED INSURANCE. THIS QUOTATION IS AN ESTIMATE AND IS NOT LEGALLY BINDING. IT DOES NOT IMPLY ANY COVERAGE HAS BEEN PROVIDED.

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