Senior Call Check Form

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Senior Call Check Form - Requests

Thank you for contacting the Senior Call Check program. You can use this form to request magnets, paper applications, and/or marketing materials. We are also available by phone Monday through Friday 8 am -5 pm and Saturday 9 am -3 pm. During these hours, seniors can call toll-free 1-866-50-CHECK (1-866-502-0560). Please note, Senior Call Check phone lines and robocalls are closed New Year’s, Memorial Day, 4th of July, Labor Day, Thanksgiving and Christmas.

Please provide your first and last name *

Please provide the phone number we call you on daily: *

Please provide your street address for mailing purposes: *

Please provide your city for mailing purposes: *

Please provide your zip code for mailing purposes: *

Please provide your email:

Please mail me the following. Please make sure to include your mailing address in the previous question. *

Senior Call Check Magnets (2)

Senior Call Check Application Form

Senior Call Check marketing materials (i.e. posters, flyers)

Other:

Required

Please provide any additional feedback and please notate if you would like someone to follow-up with you.

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