CONTRACTING REQUEST AFCR365

⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

GET CONTRACTED

⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

As an Independent Agent (1099) with one of the premier marketing partners in the nation!

Please call an Advocate with questions! 1-800-943-2386 or live chat now at www.MyAdvocateFinancial.com

***Getting contracted with Advocate, you still remain 100% Independent, and you own 100% of your own book of business***
AGENT INFORMATION ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎
1.) Independent Agent Name on Insurance License*

First NameLast Name
2.) Agent E-mail*
3.) National Producer Number*
4.) Agent CELL Phone Number*

Area CodePhone Number
5.) Resident State*
6.) Do you ASSIGN your commissions to an agency?*
7.) Name of Recruiter or Agency (If Applicable)
#1. ACA/ FFM/ Under 65 ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AETNAAMBETTERANTHEM/ELEVANCEBLUE CROSS BLUE SHIELD MICHIGANBLUE CROSS BLUE SHIELD NEW MEXICOCARESOURCECHRISTUSCIGNAMOLINAUNITED HEALTHCAREOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#2. Medicare Advantage & Drug Plans ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AETNA🔥TOP CARRIER🔥ANTHEM ELEVANCE🔥TOP CARRIER🔥BLUE CROSS BLUE SHIELD MICHIGAN🔥TOP CARRIER🔥BLUE CROSS BLUE SHIELD NEW MEXICO🔥TOP CARRIER🔥AMERIGROUPUNITED HEALTHCARE🔥TOP CARRIER🔥CENTENECIGNA HEALTHSPRINGDEVOTED🔥TOP CARRIER🔥WELLCAREHAP Health Alliance PartnersHUMANA 🔥TOP CARRIER🔥IU HEALTHMOLINAMCLAREN (MI) / MDWISE (IN) -NCDPresbyterian HealthSILVERSCRIPTZINGREGENCEPRIORITY HEALTHOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#3. Medicare Supplement ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AETNA LIFEANTHEMBLUE CROSS BLUE SHIELDCIGNA HEALTHSPRINGCONTINENTAL LIFEGUARANTEE TRUST LIFEHAP Health Alliance PartnersHUMANA 🔥TOP CARRIER🔥WELLABEMUTUAL OF OMAHANATIONAL GUARDIAN LIFEALLSTATE HEALTHPHYSICIANS MUTUALUNITED HEALTHCAREOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#4. Fixed & Indexed Annuities ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AMERICAN NATIONAL 🔥HOT PRODUCT🔥ATLANTIC COAST LIFEATHENE🔥HOT PRODUCT🔥AXONIC INSURANCE SOLUTIONSCOLUMBUS LIFEELCO 🔥HOT PRODUCT🔥EQUITRUST LIFECLEAR SPRINGS1891CATHOLIC FINANCIALNORTH AMERICAN LIFEOCEANVIEWSILAC 🔥HOT PRODUCT🔥COREBRIDGEOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#5. Final Expense Life ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AMERICAN AMICABLE 🔥HOT PRODUCT🔥AMERICAN NATIONALELCO 🔥HOT PRODUCT🔥GTL HERITAGE LIFE 🔥HOT PRODUCT🔥GERBER LIFEAETNA LIFEMUTUAL OF OMAHAWILLIAM PENNOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#6. Hospital Indemnity & Cancer/Heart/Stroke ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AETNA LifeALLSTATE HEALTHCOMBINEDGUARANTEE TRUST LIFE 🔥TOP CARRIER🔥WELLABEOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#7. Life Insurance ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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AMERICAN NATIONALAETNACATHOLIC FINANCIALCOLUMBUS LIFECOMBINEDCoreBridge 🔥TOP CARRIER🔥EQUITRUSTGERBERMUTUAL OF OMAHANATIONAL GENERAL1891NATIONAL GUARDIAN LIFEWILLIAM PENNWOMAN'S LIFEOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#8. Short Term Care ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

Featuring the industry leaders
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AETNAGTL GUARANTEE TRUST LIFE 🔥TOP CARRIER🔥Other
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#9. Funeral Trust and Pre-Need ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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NATIONAL GUARDIAN LIFEUNITY LIFEELCOOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#10. Dental Vision Hearing ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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UNITED HEALTHCAREPHYSICIANS MUTUALGUARANTEE TRUST LIFENCDHUMANAOther
IF YOU'D LIKE TO ***TRANSFER*** EXISTING CARRIER TO ADVOCATE PLEASE LIST CARRIERS HERE BELOW:
#11. Short Term Health Plan ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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ALLIED NationalALLSTATE HEALTHAMBETTERANTHEMOther
#12. Specialty ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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APASIOther
#13. Long Term Care ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

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MUTUAL OF OMAHAOther
PLEASE CONTACT ADVOCATE FINANCIAL Life & Health Brokerage with questions! 800-943-2386 or www.YourNewFMO.com
Should be Empty:

AGENT INFORMATION ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#1. ACA/ FFM/ Under 65 ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#2. Medicare Advantage & Drug Plans ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#3. Medicare Supplement ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#4. Fixed & Indexed Annuities ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#5. Final Expense Life ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#6. Hospital Indemnity & Cancer/Heart/Stroke ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#7. Life Insurance ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#8. Short Term Care ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#9. Funeral Trust and Pre-Need ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#10. Dental Vision Hearing ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#11. Short Term Health Plan ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#12. Specialty ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎

#13. Long Term Care ⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎⚫︎