Carrier Contracting Request
Are you an agent who has completed your initial carrier contracting already? (you've signed contracts for Foresters, CFG, etc)
Yes
No
This is not the correct form for you to use. Please request a contracting packet through the link below (cut and paste link):
https://form.jotform.com/203056795678166
Agent Name
*
First Name
Last Name
EF Number
*
Email
*
example@example.com
Direct Upline Manager
*
First Name
Last Name
Direct Upline Email
example@example.com
Do you have Errors and Ommissions (E&O)?
*
Yes
No
Which Carrier(s) are you requesting?
Accendo (Aetna)
American Amicable
CFG
Foresters
Great Western
John Hancock
Mutual of Omaha
TransAmerica
Which Carrier(s) requiring E&O are you requesting?
Americo (E&O)
Ameritas
Athene
AIG
Columbus Life
Gerber
Which Carrier(s) requiring RM approval are you requesting?
NLG
Oxford
F&G
Lafayette Life
One or more of your selections requires Errors and Omissions Insurance. Do we have a copy of your E&O?
*
Yes
No
Please upload your E&O certificate of insurance. If you do not have E&O, please remove the carrier(s) that require it.
*
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Regional Manager
*
Please Select
Jerrod Ewing
Eric Boling
Darren Willis
Nate Maddox
David Schneider
James Glascott
Charles Knox
Richard Hazouri
Regional Email
example@example.com
Other
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