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2010 Supply Orders

1. Print out and complete the 2010 Aetna Supply Order Form
   • You can Customize the Enrollment forms with your Agent Name and Phone Number!
   • If you have any questions on availability, go to our Aetna Products Page
2. Send the form to the Aetna Broker Service Unit in Arlington, TX
   • Fax to Broker Service team @ 1-860-975-9697
   • E-mail Form to BrokerService-MedicareTeam@aetna.com

Or, Call 1-888-247-1050 and select option 5.

Or, Click Here to Download Electronic forms!

About 2010 Enrollment Forms

• Enrollment kits this year will be produced using a state-of-the-art Print-on-Demand process (POD), allowing for real-time production of customized materials.
• Kits will have all necessary enrollment information (such as benefits summaries) contained in one booklet. Our two-part NCR enrollment forms will not be bound into the booklets, but will be included in the enrollment package inside the envelope.
• Additionally, a window on the front of the enrollment booklet will display the product offering included inside the book, your name and contact phone number. A die-cut is also available on the front cover to accommodate your business card.
•  If you have been contacted by an Aetna representative regarding a pre-order of enrollment kits, please wait until this shipment arrives before contacting the Broker Liaison Unit with additional orders.