SERVICE IN TAKE

Caring For Citizens Of Alabama

2424 EAST SOUTH BLVD.

MONTGOMERY AL 36116

OFFICE: (334) 239-3518

FAX:1(678) 401-02228

DIRECT: (334) 492-2486

Donations allow US to continue to serve.
SERVICE IN TAKE

Elon Miree- AGENT
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Name*

(FRST NAME)(LAST NAME)
Birthday*

MonthDayYear
Date
Social Security #*
Address*
City*
State*
Zip Code*
Email Address*
example@example.com
Home Phone*
Work Phone
Mobile Phone*
Please Check the following that may Interest you:
FREE Communication Devices

Tablet (Limited time)Phone (Free)Other
Senior Box Services

CSFP Senior BoxCFC BagPantryBirthday ShoppingChristmas Shopping
Medicare

Medicare ReviewNew EnrollmentSpecial EnrollmentMedicare (Disability 2 months65 or older)
Healthcare

Health Insurance 19-64 yrs.DentalDental, VisionDental, Vision, Hearing
Insurance

AutoHomeLifeBusinessOther
Taxes

Current YearBack YearAmendmentTax Resolution (reduce back pay taxes)
Financial Services

Complimentary Financial NeedsAnalysis (budget)Insurance Analysis (policy review)Debit Management (Budget)
Additional Information:

Other
Home Purchasing

BuySellerRent To Own
Spectrum

Free Phone Service with a New Internet (29.99) for a YearCableInternetWIFI TV-8600 Streaming channel
Other Valued Services

Notary ServicesLegal Services (Legal Shield)CreditHome Health Service
Career Opportunities

Earn Extra Money, Real Estate, Taxes,Insurance AgentPart TimeFull Time
Should be Empty:

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