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: _______________________________________ Telephone: _______________________________________   Type of Entity: C Corporation S Corporation Partnership Sole Proprietor Number of years in business? _____ Which insurance markets do you specialize in? (Check all that apply)   Mortgage Business Estate Planning Retirement Planning Other (List) _____________________________________________ _____________________________________________ _____________________________________________   Which products do you generally sell? (Check all that apply) Term Return of Premium Term Non-Med Term Universal Life Equity Indexed UL Variable UL Whole Life Fixed Annuities Equity Indexed Annuities Variable Annuities Other (List) _____________________________________________ _____________________________________________ _____________________________________________   How much production 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 check if you are licensed with any of these companies:   Contracted Contract Level Production   AIG _________ ____________ _________ Americo _________ ____________ _________ Assurity _________ ____________ _________ Chase _________ ____________ _________ F&G _________ ____________ _________ Genworth _________ ____________ _________ Life Investors _________ ____________ _________ National Guardian _________ ____________ _________ West Coast Life _________ ____________ _________ Please list all other companies which you are licensed with, contract level and production.   Company Contract Level Production   ________________________________ ____________ _________ ________________________________ ____________ _________ ________________________________ ____________ _________   Are there any companies that you would like to do business with that either you or we are not currently contracted with? _______________________________________ _______________________________________ _______________________________________