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By clicking the submit button on this form, I agree I am 18 years old or older. I provide my signature expressly consenting to receive text messages (sms), phone calls, emails and any other forms of communication regarding Health Insurance quotes to the number(s) provided, including a mobile phone, even if I am on a state or federal Do Not Call and/or Do Not Email registry. If you were previously registered on the National Do Not Call List, by submission of this form, you have expressly opted in to receive future communications. You will receive calls from a maximum of 2 insurance agents, either from myself or a partner of mine. Such calls and text messages will never use automated telephone dialing systems, artificial or pre-recorded voices. I understand my wireless carrier may impose charges for calls or texts. I understand that my consent to receive communications is not a condition of purchase and I may revoke my consent at any time by emailing