Aflac Interest Sheet
Aflac pays cash benefits directly to you to help cover expenses major medical doesn’t. 
Want to know more? It’s Easy!!

Complete the information below. Carla Bailey, your Aflac representative will contact you directly.

What is your name?
Your answer
What is your email address
Your answer
What is your phone number?
Your answer
What day(s) and time(s) work best for you to sit down or talk over the phone?
Your answer
What concerns you? Choose all that apply.
Column 1
Paying bills if disabled
Minor and major accidents
Having a heart attack or stroke
Getting Cancer
Being confined to a hospital
More information? Contact Carla Bailey Independent Aflac Agent/ 412-401-6109
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service