REQUIRED for each Medi-Share Application Submitted
Agents: For each Medi-share Application Submitted, you MUST submit the application data on this form for processing and payment. Once you have done this, you will receive a confirmation email from PPI notifying you that we have received your recording of an application submitted to Medishare.
Important Note: This is NOT an application.
You must submit the client application through your Medi-Share broker portal prior to completing this form.