Fill in Estimated 2026 adjusted gross income.
Last year's Adjusted gross income can be used as a reference
You can found it in Form 1040. For details, please click the button at the bottom to view the reference image.
Specialist Care Needs
Regular Medications
The last three digits of the number on the back of your bank card.
Bank Account Information
I give my permission to Carrie Lin to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace.
I agree to release my and my family's private information to Carrie Lin for insurance application and purchase.
*Stated by checking the box that the client agrees to the terms and condition on the form.
*Please send all identity documents and income proof documents to linorservice@gmail.com
