DOB

By clicking “Accept & Continue,” you acknowledge and agree that you are providing your electronic signature under the U.S. Electronic Signatures in Global and National Commerce Act (ESIGN Act), and that this electronic agreement has the same legal effect as a handwritten signature.

You also consent to be contacted for marketing communications related specifically to Medicare insurance products and services by The Hawks Media (a marketing brand/DBA of a licensed insurance agency, and its affiliated partners) or any party acting on its behalf. This may include e-mails, telephone calls, and text messages (SMS), including calls made using an autodialer, prerecorded voice, or artificial voice, which may result in charges depending on your carrier and plan. Your consent is not a condition of purchase.

You understand that you may revoke your consent at any time by using the unsubscribe link in emails, replying “STOP” to SMS messages, or by contacting us directly to opt out of communications.

By submitting this form, you also agree to the Terms and Conditions and Privacy Policy. You acknowledge and agree that any disputes, claims, or controversies arising out of or relating to your use of this website, including claims under the TCPA or other telemarketing regulations, shall be resolved through binding arbitration. You expressly waive the right to bring such claims in court, including claims against The Hawks Media, its affiliates, partners, service providers, and any third parties involved in the initiation or facilitation of communications, including but not limited to HealthPlanOne, LLC, based on information submitted through this website.

You may revoke your consent to receive marketing calls, text messages, or emails at any time and through any reasonable method, including by replying “STOP” to any text message, using the unsubscribe link provided in an email, or contacting us directly. To the fullest extent permitted by applicable law, you further agree that any dispute, claim, or controversy arising under the Telephone Consumer Protection Act (TCPA), other federal or state telemarketing laws or regulations, or otherwise relating to communications initiated or generated using information submitted through this website shall be resolved exclusively through binding arbitration. This arbitration agreement applies to claims brought against The Hawks Media, its customers, affiliates, partners, service providers, and any person or entity involved in initiating, generating, facilitating, transmitting, or placing such communications, including HealthPlanOne, LLC.