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  • English (US)
  • Producer Information Form/Contract Request

  • Welcome to the Producer Information Form/Contract Request. In just a few short steps you will be providing Loyalty Insurance Marketing Group with the information we need to get your contracting to you. Once delivered, we will follow up to help you along in the process. Thanks!

  • Appointment Type Definitions

    Individual: Commission paid direct to the agent

    Corporation: Agent contracting as an Agency/Corporation and assigning commission to the Agency/Corporation. This selection is for AGENCY PRINCIPALS ONLY

    Solicitor (LOA): Agent employed by upline and assigning commission to the upline

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  • Carrier Contract Request Selection

    NOTE: Not all carriers are available in all states.

  • Tip! We suggesting starting with a maximum of 5 contract requests. Once you have completed and submitted those contracts, return to this form to request more. 

  • NOTE: Cigna HealthSpring contract for MAPD only. PDP is not available: Contact your upline for more details.

  • Download and Review Anthem Appointment Fees

  • NOTE: Anthem requires your Social Security Number to initiate the contract. A member of our Onboarding Team will call you to obtain in order to send the contract invitation. You may also call us directly at (860) 216-0484.

  • Contact us with any questions: (860) 216-0484

  • For Loyalty Insurance Marketing Group Use Only

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  • For GarityAdvantage Use Only

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