Referral Form

Refer a friend to Kirk M. Hale

We love referrals! The greatest testament that our customers can provide is by referring their friends and family to Kirk M. Hale. Thank you for your referral, and we thank you even more for your continued business.

Your Information

First Name*

Last Name*

Your Email Address*

Your Phone Number*

Your Friend's Information

Friend's First Name*

Friend's Last Name*

Your Friend's Email Address*

Your Friend's Phone Number*

Special Comments*

Submission Validation

Insurance Websites Designed and Hosted by Insurance Website Builder

© Copyright 2000-2023 Medicare65insure.com. This website is solely owned by Kirk Miles Hale licensensed in the states listed below. NO one will contact you from this webite but me. All Rights Reserved. This website is a general description of benefits for Medicare Supplement plans. Although every effort is made as to the accuracy of the information on this website there is always the possibility of an error. If you see an error, please contact us so we can correct it. The insurance policy will always determine benefits. Please contact us for an outline of coverage provided by each of the insurance companies we represent. Not all plans are available in all areas. If you submit a quote or information request a licensed agent will contact, you. We engage in insurance sales only in the states in which we are properly licensed. We are currently licensed in AL, AR, AZ, CO, FL, GA, IA, IL, IN, KS, KY, LA, MD, MI, MO, MS, NE, NM, NC, OH, OK, SC, SD, PA, TN, TX, VA, WA & WV. Not affiliated with, authorized by or endorsed by the U.S. government or the federal Medicare program. For more information feel free to Contact Me.