Consent to Receive 1095-C Electronically

CONSENT TO RECEIVE ACA FORM 1095-C ELECTRONICALLY
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I do have access to a computer, email, and printer during regular working hours and I would like my ACA Form 1095-C to be sent to me electronically, password protected, at the following address ___________________________________________________

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I do not have access to a computer, email, and printer during regular working hours and I would like my ACA Form 1095-C to be sent to me via regular mail at the following address: _____________________________________________________________________

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Consent to Receive 1095-C Electronically

CONSENT TO RECEIVE ACA FORM 1095-C ELECTRONICALLY

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