General Acknowledgement Form

Please find below a form that needs to be completed before any tele-sales arrangements can be made. It is a requirement by the state that our agency documents a general agreement to ensure that both the client and the state representative (or their authorized representative) have a clear understanding of what will be discussed. All information provided on this form is confidential and should be completed by every person with an interest in the following products, which we offer as a brokerage service:

  • Hospital indemnity plans

  • Life insurance (final expense terms)

  • Marketplace Coverage

  • Retirement plan products (IUL, annuities, participating dividend paying whole life)

  • Dental/Vision stand alone

  • MAPD/Medicare supplements

By signing this form, you agree to meet with a licensed sales agent to discuss the above-mentioned products. Please note that the sales agent is either employed or contracted under the regulated guidelines for this state's active license and is acting on behalf of Legacy Wealth Advantage LLC. They do not work directly for the federal government. This individual may also be paid based on your enrollment in a plan.

It is important to note that signing this form does NOT obligate you to enroll in a plan or affect any currently enrolled products. Neither will it enroll you in anything without your consent. Further application and process would be required for enrollment, and that too only with your consent.

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