ACA / Marketplace Consumer Consent Form

Please review and sign this form so Zaki Enterprise can help you with your Health Insurance Marketplace application. It takes about two minutes. Please do not enter your Social Security number or Medicare number on this form.

Questions? Call 281-827-7915 or 281-741-9658, or email zakitxusa@gmail.com.

This form is for ACA / Marketplace health insurance clients. Zaki Enterprise is licensed for health and Medicare in TX, FL, GA, MS, NJ, NV, NY, OK, TN, LA, CO, and MI.