Agent Info Form
We are EXCITED to announce a new partnership with Creative Financial Network (CFN), based in Fort Lauderdale. This partnership will provide us with robust organization support for YOUR growth and success!
We need you to complete this form so we have the information to send to CFN to start the contracting process.
Name (Legal name as it appears on your insurance license)
*
First Name
Middle (optional)
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Experience Level (note: our agreement with OneAmerica requires an assessment to be completed to be eligible for benefits)
*
Inexperienced (less than 2 years in the business)
Experienced (2+ years)
Career Track
*
Stewardship Advisor -- full-time Career Agent (non-captive, benefitable contract)
Relationship Manager -- part-time (full back-office support, without benefits or free CRM)
NPN (National Producer Number)
*
Licensed in
*
Life / Health
Property / Casualty
Who referred you to Petra?
Carl Johnson
Brian Harris
Garnet Walters
Other
Any additional questions or comments
Submit
Should be Empty: