Order Plan Materials Form - NHRMC Health Advantage

Need sales material for your next appointment? Let us know what materials you need by completing this online form. We will get back to you to confirm your order!

Agent/Broker Name*
Physical Shipping Address*
Street Address Address Line 2 City State
Zip Code*
Phone Number*
Enter the quantity of Information Kits you would like to receive. Remember the Information Kits contain the summaries of benefits, plan information, star ratings, etc. The Enrollment Kits are all the forms you need to enroll a beneficiary.
New Hanover Health FirstMedicare Platinum and Select HMO-POS Infromation Kits
Please enter a number greater than or equal to 0.
Email Address*
Email Address * Confirm Email Address *
Special Instructions

Agent & Broker Material Order Form