Paper Application and Mail-in Option

Click the PDF PrimeTime Choices Enrollment Application 'Download File' link below the preview,  to save, print and complete. 

* Coverage is contingent upon PrimeTime Choices approval of this application.
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Review the application below, to preview the questions.  

Download the Enrollment Application

PrimeTime Choices EFT Form

You may mail the completed application to:
PrimeTime Choices
PO Box 9975
Canton, OH 44710

A drop box for completed applications is available at our office location:

PrimeTime Choices
Morrow House Building
2600 6th St SW
Canton, OH 44710

Click the PrimeTime Choices Guide below to download the information found on this website.

Click the Choosing a Medigap Policy cover to download the official guide from Medicare

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