Agent Appointment Application
Agency Name
*
As listed on your W-9
Agency NPN
*
Please verify on NIPR: https://nipr.com/help/look-up-your-npn
Agent Name
*
First Name
Last Name
Agent NPN
*
Please verify on NIPR: https://nipr.com/help/look-up-your-npn
Email
*
example@example.com
Resident State
*
AZ
CO
IL
NJ
NY
TN
TX
VA
WI
Agency Management Info
IVANS Y-Account
*
Input N/A if you don't have an IVANS account
IVANS User ID
*
Input N/A if you don't have an IVANS account
Which Rater do you use?
*
EZLynx
PL Rater
ITC Turborater
No Rater
Other
What is your entity's tax classification?
*
Sole proprietor
C Corporation
S Corporation
Partnership
Limited Liability Company
SUBMIT
Should be Empty: