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Last updated: 01.05.2023 at 12:01 AM MULTIPLAN_SHDLEAWE001_M.

By submitting a request for quotes, I expressly consent (electronic signature) to receive emails and phone calls via automatic telephone dialing system or by artificial/pre-recorded message, or by text message, from licensed sales agents of LocalMedigap, or Companies and their Partner Companies at the telephone number above, including my wireless number if provided, message and data rates may apply. I understand that my consent to receive communications in this way is not required as a condition of purchasing any goods or services. If you are Medicare-eligible, a licensed sales agent will contact you about Medicare Advantage, Prescription Drug Plan, and Medicare supplement plans by phone or email. Submitting this form does NOT affect your current Medicare Part A and Part B enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, Medicare supplement plan, or other Medicare plan. I acknowledge this is a solicitation for insurance and I have read and understand the Terms and Conditions and Privacy Policy of this site and agree to be bound by it. Consent can be revoked by any reasonable means.