Annual Enrollment Period is here October 15th - December 7th! We're here to help...

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Client Information Form & SOA Current (pdf)Download

Return To:

After completing your Client Information Form (CIF) and Scope of Appointment (SOA), 

please return to:


DRC Insurance

P.O. Box 7591

Chandler, AZ  85246

or 

Email: support@drcinsurance.com

or

Fax: 866.606.8911

Thank you!

After we receive and review your information we will be in contact with you soon. 

We pride ourselves in giving our 'Boy Scout best' to find an effective and affordable plan   

that works for you. Looking forward to scheduling a time to review your options together!

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We respect your privacy and will never sell, rent, lease or give away your information (name, address, email, etc.) to any third party (We hate spam too!), nor will we contact you by phone, email, or text without your permission. All personal information entered is secured and HIPAA compliant.  


Disclaimer: Medicare has neither reviewed nor endorsed this information. We are not connected with or endorsed by US government or federal Medicare program. We do not offer every plan available in your area. Currently we represent 16 organizations which offer 84 products in your area. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

By clicking the "Submit” or "Send" button, you are agreeing by electronic signature to give DRCInsurance.com consent to contact you at the phone number or email you provided above. Clicking any button is not a condition to purchase. By completing the "Quote or Consultation Request" form or calling the number listed above, you will be directed to Darrell R. Crum, a licensed agent for over a decade in Arizona NAIC.  He can answer your questions and provide information about Medicare Advantage, Part D, or Medicare Supplement insurance plans. Availability of carriers and products are dependent on your resident zip code. To opt-out of communications please email support@drcinsurance.com.

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