Texas Assurance Care - Info Request

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Information Request Form

Please select the information categories and the level of importance to you. Enter your comments or specific questions, then enter your contact information below, so that we may respond to your request.

(I NEED THE FOLLOWING ASSISTANCE/ INFORMATION):

Planning Objectives - Level of Importance

Retirement Planning Assessment :

HIGH--MEDIUM--LOW--DON’T KNOW

Getting Estate in Order :

HIGH--MEDIUM--LOW--DON’T KNOW

Understanding Medicare Options:

HIGH--MEDIUM--LOW--DON’T KNOW

Understanding Long-term care Options:

HIGH--MEDIUM--LOW--DON’T KNOW

Reducing Financial Risk Exposure:

HIGH--MEDIUM--LOW--DON’T KNOW

Creating Guaranteed Lifetime Income:

HIGH--MEDIUM--LOW--DON’T KNOW

Review of Legal Documents:

HIGH--MEDIUM--LOW--DON’T KNOW

Evaluating Life Insurance Needs:

HIGH--MEDIUM--LOW--DON’T KNOW

Annuities as Planning Tools:

HIGH--MEDIUM--LOW--DON’T KNOW

Review of current life insurance, Medicare:

HIGH--MEDIUM--LOW--DON’T KNOW

Assisting Aging Parents:

HIGH--MEDIUM--LOW--DON’T KNOW

Comment:

First Name*:

Last Name*:

Address:

City:

State:

Phone:

E-Mail:

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Best Time to Call...:

Morning--Afternoon--Evening

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