Processing and Application Call-Outs!
• Available via E-App: ManhattanLife's online application enrollment/ quoting tool (10 Easy Steps in the Agent Guide).
• Submitting Paper Applications: Fax – 1-866-754-9350 Attention: New Business Mail – P.O. Box 510690 Salt Lake City, UT 84151-0690.
Required Information
Complete residential address
• • • •
Date of birth Plan selection Correct Premium
• Bank draft date/Policy effective date • Eligibility questions • Applicant’s signature • Agent’s signature • Agent Number
Required Forms: 1. Replacement Form is required if agent is replacing insurance. (GA state specific replacement form) 2. Bank Draft Authorization Form : If client’s elects to pay premiums via bank draft. (EFT) 3. HIPAA Authorization Form.
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