Agent appointments

male and female agent coworkers viewing a tablet together

Agent appointment application

Use this application to add new agents to your Agency or Brokerage account.

If you do not yet have an account, please see the New Agency (Brokerage) form. If you are a sole proprietor or independent agent, please see the Sole Proprietor form.

Processing time for agent applications can take up to two weeks. You will receive a welcome email notifying you when your appointment is complete.

Required attachments to be uploaded with application

  • State insurance license(s)

Have questions or need help? Email us at [email protected] or call us toll-free at 877-317-3046

Application form

*required

**We partner with these Field Marketing Organizations for Medicare sales. Check the one that applies.
Please answer the following questions truthfully and completely. Please include an explanation of any "yes" answers in the text box provided below.
Please include dates, persons and  government entities involved, and attach relevant documentation, such as court decrees or findings of investigation.
Please use a mouse or your finger to sign your name in the box above.