Producer Information Form/Contract Request
Welcome to the Producer Information Form/Contract Request. In just a few short steps you will be providing GarityAdvantage with the information we need to get your contracting to you. Once delivered, we will follow up to help you along in the process. Thanks!
Appointment Type Definitions
Individual: Commission paid direct to the agent
Corporation: Agent contracting as an Agency/Corporation and assigning commission to the Agency/Corporation. This selection is for AGENCY PRINCIPALS ONLY
Solicitor (LOA): Agent employed by upline and assigning commission to the upline
Carrier Contract Request Selection
NOTE: Not all carriers are available in all states.
Tip! We suggesting starting with a maximum of 5 contract requests. Once you have completed and submitted those contracts, return to this form to request more.
NOTE: Cigna HealthSpring contract for MAPD only. PDP is not available: Contact your Territory Manager for more details.
NOTE: WellSense REQUIRES your name on this form match your legal name on your state license. Please take care to complete the form correctly. Example: Joseph (Correct!) vs Joe (Incorrect!)
Download and Review Anthem Appointment Fees
NOTE: Anthem requires your Social Security Number to initiate the contract. A member of our Onboarding Team will call you to obtain in order to send the contract invitation. You may also call us directly at 800-234-9488.
Contact us with any questions: 800-234-9488