By checking this box, you agree to receive communication from Ideal Retirement Roadmap or meet with a Licensed Sales Representative to discuss the products checked above.  The Licensed Sales Representative is contracted by a Medicare plan and may be paid based on your enrollment in a Medicare plan.  They do NOT work directly for the federal government. This appointment is a solicitation for insurance.

Signing this form does NOT affect your current or future enrollment in a Medicare plan, enroll you in a Medicare plan or obligate you to enroll in a Medicare plan. All information on this form is confidential.

David Westgate-(NIPR #19588923) Currently, we represent 8 organizations which offer 40 products in the Bristol and Plymouth Counties area. Contact us about other areas. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.

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