I am contracting as an Incorporated Entity, Partnership or LLC
Please scroll all the way to the bottom of this window to make sure you answer all necessary business practices questions.
If LOA Only, DO NOT complete Commission Advance Addendum
Type of Contract (Select One)
Entity (Select One or More)
Choose Commissions Advance Period for Health Insurance:
Choose Commissions Advance Period for Med Supp:
If "Yes", pick one advancing period
BCBS IL, NM, OK, TX: Please indicate the market segments to be sold and serviced?
⚠️ BEFORE PROCEEDING: do you have copies of E&O, License, AHIP, and a voided check? You will need them to proceed.
⚠️ We have disabled and grayed out all questions not relevant to the carrier contracts you have selected.
⚠️ Heads up, this process should take between 15 to 20 minutes to fully finish.
⚠️ DO NOT refresh your browser window or use the back or forward browser buttons. If you do, you will lose any information you have already input.