Click below to fill out our electronic Scope of Appointment. You’ll only need to complete the sections that are highlighted. Please initial in the boxes above and sign below. It’s best if you can print, sign, and email the form back to us. If you don’t have a scanner, then a good qualify photo from your phone will suffice, just take the photo and send it to us. If you are unable to print the form, you can just type in your initials and signature where indicated, then follow the instructions below. Please note we are required by law to obtain this form before we can discuss Medicare Advantage products with you. You may also drop the form by our office if that is easier for you.
Note, once you click the link above, it will open a new tab with the electronic Scope of Appointment ready for you to complete. Once you’ve filled in the highlighted fields only, then click the ‘Print’ icon in the upper right and then save the document as a pdf. Once you’ve saved the document, then you can click on your agent’s name below which will open an email message to them. You can then attach the file and send it to them.
If you hit any snags or need any help please give us a call! Take care.