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title: SIFT Intake Form – Customer Service-  Staff Landing Page
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![sift-logo](https://www.jaragent.com/hs-fs/hubfs/Logos/sift-logo.png?width=209&height=88&name=sift-logo.png "sift-logo")

# Let our trusted brokers help prospective members enroll in a health insurance plan that fits their needs. 

### Call now: [209-203-1942](tel:2092031942)

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### Complete the form below on behalf of the prospective member to request a call back from a licensed insurance agent.

I agree to have a licensed insurance agent from JAR Insurance Services  
contact me and understand that I can opt-out at any time. 

Additionally, I have read the [Privacy Policy](http://www.jarinsuranceservices.com/privacy-policy/) and [Terms and Conditions of Use](http://www.jarinsuranceservices.com/terms-of-use/).  
For accommodation of persons with special needs at meetings call 877-391-9988 (TTY 711). 

##### We'll be the only one to call you. We do not share or sell your information with anyone. 

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