ISM - Comprehensive-Advanced-High Commission

COMPREHENSIVE - ADVANCED - HIGH COMMISSIONS

Thank you for your interest in letting us help you grow your business. Getting contracted with us is an easy and painless process. Before you can begin marketing and selling our products in the marketplace you must be contracted with us and the insurance carrier. If you are a licensed agent, you can start the process by filling out and submitting the questionnaire below and an ISM team member will contact you shortly.
Name*
Street*
City/State/Zip*
Office Phone*
Mobile Phone*
Email*
example@example.com
I am:

Looking for a new affiliationLooking for a new marketLooking for a new product
What kind of products do you currently sell?

Term LifeUL or Whole LifeAnnuitiesIndividual RetirementGroup HealthIndividual HealthOther
What is your market?

Self-employedOnline ApplicationsIndividualSenior
Companies appointed with
Years selling insurance
In which states are you licensed?
Are you a manager?

YesNo
If yes, how many agents?
Do you own your own agency?

YesNo
If yes, how many agents?

YesNo
If yes, how many agents?
Do you own your own agency?

YesNo
Do you personally write business through an agency?

YesNo
Are you a broker?

YesNo
ISM is committed to protecting and respecting your privacy. and we'll only use your personal information to administer your account and to provide the services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you If you consent to us contacting you for this purpose.

I agree to receive other communications from Interstate Specialty Marketing Inc. ISM may contact me via email, telephone or postal mail, If the phone number have provided is a mobile phone number, agree that ISM may contact me via text message or voice.

Youmay unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committedto protecting and respecting your privacy, please review our Privacy Policles

By submitting this form, you consent to allow ISM to store and process the personal information submitted above to provide you the content requested
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