Agency: AR Financial or Ashley Bailey
NPN: 17591529
Phone: 210.816.3284
Email: a.r.financialsllc@gmail.com
Agent Assigned: Ashley B.

I give my permission to Ashley Bailey, of AR Financial to serve as the health insurance Agent or Broker for myself and my entire household, for purposes of enrollment in a Qualified Health Plan offered on the ffm. By consenting to this agreement, I authorize the above mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by phone for searching marketplace, completing an application for eligibility and enrollment, providing ongoing account maintenance and enrollment assistance, responding to inquiries from marketplace regarding my application. I understand that the agent will not use or share my personal identifiable information for an purposes other than those listed above. The agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes listed above. I confirm that the information I provide for entry on my marketplace eligibility and enrollment application will be true to the best of my knowledge. I understand that I do not have to share additional personal information about myself or my health with my agent beyond what is required on the application for eligibility and enrollment purposes. I understand my consent is remain effective until I revoke it, and I may revoke or modify my consent at any time by contacting my agent.
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