KAZ COMPANY

INDEPENDENCE

One Independence Place
4807 Rockside Road, Suite 660
Independence, Ohio 44131

KAZ COMPANY

MENTOR

9169 Mentor Avenue
Mentor, OH 44060

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This is a solicitation of insurance. By submitting this form, I agree to be contacted by a licensed insurance agent for the marketing of Medicare Insurance products (i.e., Medicare Advantage Plans (Part C), Prescription Drug Plans (Part D), and/or Medicare Supplement (Medigap) Products) and services. I’m aware the person who will discuss the products is a licensed and certified representative of Medicare Advantage organizations and/or stand-alone Prescription Drug Plans. Each of the organizations they represent has a Medicare contract. This individual may also be paid based on my enrollment in a plan. Enrollment in any plan depends on contract renewal. I am aware that the person who will contact me is not affiliated with or works directly for the Federal government. I understand that I may be contacted via telephone, email, text messaging, artificial or prerecorded voice messages, or automatic dialing at the contact information provided above (even if my number is currently listed on any state, federal, local, or corporate Do Not Call list). Carrier data use charges and rates may apply. I understand that my consent is voluntary and is not a condition of purchasing any goods or services, and that I may change my preferences at any time.



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We do not offer every plan available in your area. Currently we represent up to 11 organizations which offer up to 165 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

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