http://mobile-marketplace.net Reserve the OCI Mobile Marketplace Please use the form below to request the OCI Mobile Marketplace for your town or city. After you submit the form, we will contact you with more details on availability, etc. Question Title * Contact Information Name: Agency or Business: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Question Title * Please select a date for your Mobile Marketplace event: Event Date: Pickup Date: Dropoff Date: Question Title * What hours would you like to schedule for your event? (eg. 10:00am to 7:00 pm) Question Title * Where would you like to take the RV? Park it outside agency or business Grocery or other store Parade Tailgate Other Event (please explain) Question Title * OCI/Carrier Appointments/Marketplace Certification I verify I am Marketplace certified and appointed through OCI to write policies for BCBSNE, UHC, Coventry of NE, and Medica. Question Title * How will you be promoting your event? Newspaper ad Local flyers around town Radio ad Social Media Linked with enrollment at business Not Applicable - This is for a private event Other (please specify) Question Title * Marketing prior to your event is critical for success. Please describe your marketing plan. Question Title * Other Notes: * Please note that we will do our best to schedule you for your desired date and time, but certain days may not be available or we may not be able to guarantee your date if you are unable to pick up/drop off the RV from our office or another location on our route. All RV requests must be approved by OCI management. We will contact you promptly to inform you of availability. Thank you for your understanding. Submit Your Request!