Agency Engineer — Producer Application
Takes about 5 minutes. Strong producers may also be considered for an advisor role at Policy Engineer or Asset Engineer.
About You
Full name
*
First Name
Last Name
Email
*
example@example.com
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Resident state
Are you full-time or part-time?
Full-time
Part-time
Transitioning to full-time
Licensing & Credentials
Years licensed
*
National Producer Number (NPN)
Which licenses do you currently hold?
*
Life
Health/Medicare
Annuity
Long-Term Care
P&C
Securities/Investments
Securities registrations (if any)
SIE
Series 6
Series 7
Series 63
Series 65
Series 66
None
States you are licensed in
Active E&O coverage?
Yes
No
AHIP certified (this plan year)?
Yes
No
Not applicable
Your Current Business
Where are you currently working or contracted? (agency / FMO / IMO)
Carriers you are currently appointed with
How do you generate leads today?
Referrals
Paid ads
Seminars/Webinars
Purchased leads
Cold outreach
Other
Production
Year-to-date production
Last 12 months production
Average cases / policies per month
Average case size
Goals & Fit
What are you looking for?
*
Independent agent — Agency Engineer
Open to an employed advisor role — Policy Engineer / Asset Engineer
Not sure — open to options
What are your goals for the next 12 months?
Which products do you want Agency Engineer to help you contract for and sell? (this sets your contracting path)
*
Life, Annuity & LTC only (no Medicare)
Medicare only
All — Life, Annuity, LTC + Medicare
Your production over the last 12 months
Under $25k
$25k - $100k
$100k - $250k
$250k+
What support are you looking for from your ideal FMO/upline?
Marketing
Lead generation
Sales
Operational
Back-office & licensing
Technology & CRM
Anything else we should know?
Submit Application
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