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Thank you for your interest in the product partnerships available through GetHealthInsurance Agency. Please read the electronic signature statement of understanding. Check the box to agree to the statement and proceed to Contract and Signature page.

By electronically signing and submitting this Contract, you hereby consent to transmission of this Contract as an electronic record instead of in paper form. You also have the option of executing the contract in paper, if you choose. To continue with a paper contract, download and print the contract, sign and mail completed contract to:
Attn: Broker Recruitment
7440 Woodland Dr.
Indianapolis, IN 46278

UnitedHealthOne® is a brand representing the portfolio of insurance products offered to individuals and families.

Not For Consumer Use
© 2017 United HealthCare Services, Inc.

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