Request contact from Bruce Inman, FL Agent
It would be my pleasure to help you get the information you need to make an informed decision for your insurance needs. Health - Life License P103187 (NOTE: Click SUBMIT at bottom of form)  
 
The following is a required Disclosure:
This is a solicitation of insurance. By providing this information, you
agree that an authorized representative or licensed insurance
agent/producer may contact you by phone, email, or mail to answer your
questions or provide additional information about Medicare Advantage,
Part D or Medicare Supplement Insurance plans.
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First name *
Middle name or initial *
Last name *
Your home address
This answer is optional now - I do not mail information. We will either meet or use email
Home phone
Mobile phone
Additional phone (work)
only list if OK to call you at this number
Email address
Answer is optional, but helpful. If you do not use email just enter NONE below
What is your date of birth?
Optional answer, but I must have it to prepare a quote.
Would you prefer to have an "online - shared screen + phone" appointment prior to meeting in person?
I value your time and mine. Online appointments available 7 days a week from 8:00 am to 9:00 pm
What are your questions and concerns about insurance or "non-insurance" products?
Your answer may help us save some time when we talk
What do you like about your current insurance plan(s)?
What do you dislike about your current insurance plan(s)?
If enrolled in Medicare Parts A and B, when did you sign up?
Are you enrolled in Medicare Part C (medicare advantage)? Which company/plan?
If YES, which plan and do you have Part D coverage?
Do you currently have a medigap (supplement) plan? Which company/plan?
If YES, do you have drug coverage included?
Do you also have a hospital indemnity plan? Which company/plan?
This type of plan may provide additional coverage and benefits
Do you have a discount OR insurance dental plan now?
If YES, which company or plan?
Please click on SUBMIT to complete your request - thanks
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