How to I get Started with WIN?
Please complete all information completely. All requests for contracting are reviewed by a committee to place you at the appropriate level. All information is confidential.
*Name:
*Agency Name:
*Address:
*City: *State: *Zip:
*Telephone:
*E-Mail Address:
Type of Entity: C CorporationS CorporationPartnershipSole Proprietor
Number of years in business?
*Which insurance markets do you specialize in? (Check all that apply)
MortgageBusinessEstate PlanningRetirement PlanningOther (List Below)
*Which products do you generally sell? (Check all that apply)
TermReturn of Premium TermNon-Med TermUniversal LifeEquity Indexed ULVariable ULWhole LifeFixed AnnuitiesEquity Indexed AnnuitiesVariable AnnuitiesOther (List Below)
How much did your agency produce last year?
How much do you expect to produce this year?
How many agents do you have under contract?
Listed below are the companies that we currently do business with. Please state the carriers you are licensed with, contract level and production.
Carrier
Licensed
Contract Level
Production
AIG
Americo
Assurity
Chase
Genworth
Life Investors
Old Mutual
National Guardian
West Coast Life
Please list all other companies which you are licensed with, contract level and production.
Are there any companies that you would like to do business with that either you or we are not currently contracted with?
.
