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FAX COVER LETTER (Please ignore this form if you ZLOOEHPDLOLQJRUVFDQDQGHPDLOLQJ.)**Please FAX this cover letter with the completed application to: Century Benefits FAX# 5039222348Dear Century Benefits,

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Step 1: Obtain a copy of the CoverOregon paper application form.

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Step 2: Fill in your personal information, including your name, address, date of birth, and contact information.

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Step 3: Provide information about your household, including the names and ages of everyone living with you and their relationship to you.

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Step 4: Fill out the financial information section, including your income, assets, and expenses.

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Step 8: Make a copy of the filled-out application for your records.

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Anyone who is seeking health insurance coverage through CoverOregon can use the paper application form. This can include individuals who do not have access to a computer or the internet, prefer a physical form, or have difficulty navigating the online application process.

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