Fill out the form below and click submit to talk to Stephanie Floyd about Medicare There was an error trying to submit your form. Please try again. Medicare Permission To Contact Complete and sign to request contact about the Medicare topics selected below. Beneficiary Name * This field is required. Phone * This field is required. Email * This field is required. I authorize Stephanie Floyd / Summit Shores Advisors to contact me by (check all that apply): Phone Call * This field is required. Text Message (SMS) * This field is required. Email Medicare topics I am requesting information about (check all that apply): Medicare Advantage (Part C) Medicare Supplement (Medigap) Prescription Drug Plans (Part D) General Medicare Questions Agent Name This field is required. Agency This field is required. By signing, I request and authorize Stephanie Floyd / Summit Shores Advisors to call, text and/or email me using only the methods I checked, regarding only the Medicare topics I selected. I understand that consent is not required to purchase insurance and I may revoke it at any time, including by replying STOP to a text. Message and data rates may apply. Frequency varies. Reply STOP to cancel at any time. This does not authorize enrollment or replace a Scope of Appointment when one is required. Signature * Type or sign in box This field is required. Date * Today's date This field is required. Submit There was an error trying to submit your form. Please try again. Book An appointment
