ARS Enrollment Form
Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Office Number
*
Please enter a valid phone number.
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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What plan do you choose?
*
Please Select
Plan A - 1-Year Commitment
Plan B - 6-Month Commitment
Plan C - Month-to-Month Commitment
Do you plan to enroll with Sidekicks (www.arsidekicks.com) in the next 7 days?
*
Please Select
No
Yes
If so, which service with Sidekicks?
Please Select
Service Sidekick
Financial Sidekick
Executive Sidekick
Frontline Rep
None
Total Household Count
*
MOA Household Count (if applicable)
TASP Household Count (if applicable)
How long are you servicing the TASP (if applicable)?
Please list other states in which you write a substantial amount of business (more than 15%), if applicable
Do you have an additional laptop currently in your possession that you would be willing to provide to your assigned Specialist if needed?
*
Please Select
Yes
No
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Are you an Agent Intern?
*
Please Select
Yes
No
If yes, what is your estimated appointment date?
-
Month
-
Day
Year
Date
If applicable, who referred you?
Comments
Please use this box to add any special instructions or requests that our team should be aware of when pairing you with a Remote Service Specialist (examples - bilingual, in-state or multiple states needed, specific team member requests, etc).
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Sign by typing in your Full Name
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ARS Enrollment Fee
*
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( X )
ARS Enrollment Fee
$
875.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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