Request Onboarding

Just fill out the form with New Agent Information

First Name *

Last Name *

New Hire Email *

Upline Email *

New agent Phone number *

Is Agent Licensed *

Life or Health Only *

Transfer From Another Agency *

NPN Number

Compensation Level *

Will you be contracting as a business entity? (Your business must be licensed to sell insurance in your state.)

Upline Name *

Does the new agent have any existing contracts? *

Yes

No

Admin Name *

Additional notes *

Disclaimer:

Please be advised that if Upline does not provide sufficient data, delays will occur in the contracting process for new agents. To ensure a smooth and timely onboarding process, we kindly request that you provide all necessary and complete information, including writing numbers for any previous carriers and details of existing contracts. Failure to provide the required data will directly affect the efficiency and speed of the contracting process.