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Sole proprietor

Sole Proprietor application

Thank you for your interest in joining us as a sales partner! Use this form to apply for contracting if you are a licensed agent doing business independently.

If you are seeking a contract for your agency and will have more than one licensed agent, please contact us. If you are seeking appointment through the account of an agency or brokerage that has an existing contract, please see our Agent Appointment form.

Our sales leadership team review all applications for new contracts. If approved, your contract will go into effect the month you submitted your application.

Required attachments to upload with application

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

Application form


**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 use a mouse or your finger to sign your name in the box above.

Have you attached all the proper documents to this application? Your application will not be processed without all of the proper documentation that is needed with this request.