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1. I acknowledge that Sunflower Senior Solutions is not affiliated with Medicare, CMS or any government agencies.
2. I give my written consent for a Sunflower Senior Solutions staff member or agent to contact me through the contact information I have provided in this form.
3. I hereby request a Medicare Supplement quote from Sunflower Senior Solutions. I acknowledge and understand that I will be contacted by a licensed insurance sales agent regarding the purchase of a Medicare Supplement plan.