Medicare Agent Contracting

I hereby represent that the answers and statements (the “information”) I am providing Pandora Insurance on this application are correct, complete, and true, to the best of my knowledge. By submitting this form agent authorizes Pandora Insurance to submit a request for appointment to insurance carriers selected on the agent’s appointment request form, on Agent’s behalf. Agent agrees to complete any documentation reasonably requested by any insurance carrier. I understand that my agency may contact me when I need to answer carrier specific questions.