Broad form cause of loss

By checking this box and submitting this form, I consent and agree to receive marketing communications regarding Medicare plan options from Quottes as described below:

These communications may include:

• Telephone calls (including those using an autodialer or prerecorded/artificial voice),
• SMS/MMS text messages,
• Emails or other electronic messages.

I understand and agree to the following:

• My consent is specific to Quottes and does not authorize contact from any other company,
• I am providing this consent voluntarily and understand that it is not a condition of purchase,
• I may revoke my consent at any time by contacting Quottes at Richard_theo@hotmail.com,
• I am the authorized user of the phone number provided and am at least 18 years old,
• I acknowledge that message and data rates may apply.