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Infinity Insurance Solutions
Accelerator Application
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1
Name
*
This field is required.
First Name
Last Name
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2
Phone Number
*
This field is required.
Please enter a valid phone number.
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3
Email
*
This field is required.
example@example.com
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4
How Long Have You Been Licensed
*
This field is required.
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5
What Markets Do You Sell
*
This field is required.
Under 65
Long Term Care
Medicare
Dental/Vision
Supplement/Ancillary
ACA
Short Term Medical
AME
AD&D
Critical Illness
Hospital Indemnity
Group
Telehealth
Other
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6
How Many Policies Did You Sell Last Year
*
This field is required.
0
1 - 10
11 - 20
21+
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7
How Comfortable Are You With Stacking
*
This field is required.
Very
What's Stacking?
Somewhat
Type option 4
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8
Please Select Your Resident State License
*
This field is required.
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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9
Please Select ALL Non Resident States You Are Licensed To Sell In
*
This field is required.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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10
How Many Hours A Day Can You Commit To Taking Calls? What Would An Ideal Schedule Look Like For You?
*
This field is required.
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11
Are You Contracted With Another FMO?
*
This field is required.
YES
NO
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12
Please Select Any Carriers You Are Currently Appointed With
Allstate
Pivot
Manhattan
PRAM
Philadelphia American
LifeX
AFEUSA
NEO/Pinnacle STM
Enrollment 1st
Iron Health
USA Health Plans
USA Insure
Balance Care
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13
Can You Commit To 18 Months To Build Your Book Of Business
*
This field is required.
YES
NO
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