Request to Add Contracts or Update Information

Your Information

Upload your resident state license reflecting your new name.
This information will be used to make sure all instances of your former name are updated.

Enter your new name when completing below.

Enter your OLD email address when completing below.

Licenses

Upload copy of state insurance license. A screenshot of your state website showing your active license is acceptable if saved and uploaded as a PDF.
In order to contract and receive commissions as a business, the business must have a license, National Producer Number, and an EIN.

Please obtain an insurance license for the business or proceed with contracting as an individual.

Direct Deposit Information

Agents are responsible for updating their banking information with already contracted carriers. The information added today will be kept on file and used for all future requests.

The information entered today will only be used for future contract requests. must be Read.

Enter the account information where you wish your commissions to be deposited. 

This information is never used for billing purposes; only for bonuses, commissions, and overrides.

Checks must be printed with your information, blank starter checks not accepted. Typed bank direct deposit or EFT forms are also accepted. Most banks have direct deposit forms available for download through online banking.
By signing below I hereby authorize the Company to initiate credit entries and, if necessary, adjustments for credit entries in error to the checking and/or savings account indicated on this form. This authority is to remain in full effect until the Company has received written notification from me of its termination.  I understand that this authorization is subject to the terms of any agent or representative contract, commission agreement, or loan agreement that I may have now, or in the future with the Company.
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Carrier Selection

Select "Update Only" at the bottom of the list of carriers if you only needed to update your information and do not wish to add another carrier.

(*) denotes a preferred carrier

Click Here to View Carriers Available in New York

If a carrier you want is not listed, please add to bottom of list under "other" and the Contracting Team will follow up with you by email regarding your request.

Agents can add no more than five carriers.

Coverage through another IMO or FMO is not valid, the policy must be owned by you to contract with Allianz, Lincoln Financial, Minnesota Life, Nationwide, and Symetra. CLICK HERE  to purchase.

A new client application for insurance is required to contract with Allianz, American Equity, Athene, Lincoln Financial, Minnesota Life, Mutual Trust, Nassau RE, National Western, Nationwide, North American, and Symetra.

AmAm requires their own Anti-Money Laundering training that must be uploaded to submit contracts.  CLICK HERE to complete their course then upload the certificate of completion PDF.

CLICK HERE to download and complete the required Georgia Background Check Authorization.

Falsely answering "no" and not completing the required Transfer Form will result in contracting being delayed up to 6 weeks as the carrier will reject your request and you'll have to start over.

CLICK HERE to complete the required transfer form and then upload. If you have EVER been contracted with Mutual of Omaha they WILL require this form. Not submitting now will delay re-contracting for as much as 6 weeks.

Nassau RE Contracting Instructions

To submit business online: 
Go to https://salesnet.nfg.com/illustrations.html Note that the policy you are submitting is to issue under Jason Thornton/Partners Life Agency. Note the submission confirmation below.

To submit a paper application: 

In the agent remarks section, note that the policy you are submitting is to issue under Jason Thornton/Partners Life Agency. Upload below.

Include client's name and policy/confirmation you received after submitting application at https://salesnet.nfg.com/illustrations.html

Make sure that you have noted in the agent remarks section that this policy is to issue under Jason Thornton/Partners Life Agency.

National Life Group Questionnaire

Falsely answering "no" and not completing the required Transfer Form will result in contracting being delayed up to 6 weeks as the carrier will reject your request and you'll have to start over.

Complete, sign, and upload the required NLG Transfer Form.  Only your signature is required unless you need a release from your previous upline to move your contract.  If you're not sure if you need your former upline's signature to transfer, you can call NLG directly and they will let you know:  (800) 906-3310.

Falsely answering "no" and not completing the required Transfer Form will result in contracting being delayed up to 6 weeks as the carrier will reject your request and you'll have to start over.

Click here to complete the Transamerica Transfer Form and then upload here.

Proof of new business is required for either transfer or multiple relationship requests. Please upload completed client paper application for insurance. Email [email protected] with the name of the application you need and the state for the most up to date application.

It is my responsibility to contact the carriers I'm already contracted with and update my information directly with them. The changes I request today will only be applied to future carrier contract requests.

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Authorization to Submit Contracts and Disclosures

By signing and submiting this electronic request I understand and agree to the following:

I hereby authorize Partners Life, their affiliates, and SuranceBay, LLC to affix or append a copy of my signature, as set forth below, to any and all required signature fields on forms and agreements of any insurance carrier designated by or for me through the SureLC software or through any other means, including without limitation, by eMail or orally. The Authorized Parties shall be permitted to complete and submit all such forms and agreements on my behalf for the purpose of becoming authorized to sell Carrier insurance products. I hereby release, indemnify and hold harmless the Authorized Parties against any and all claims, demands, losses, damages, and causes of action, including expenses, costs and reasonable attorneys' fees which they may sustain or incur as a result of carrying out the authority granted hereunder.

By my signature below, I certify that the information I have submitted to the Authorized Parties is correct to the best of my knowledge and acknowledge that I have read and reviewed the forms and agreements which the Authorized Parties have been authorized to affix my signature.  I agree to indemnify and hold any third party harmless from and against any and all claims, demands, losses, damages, and causes of action, including expenses, costs and reasonable attorneys' fees which such third party may incur as a result of its reliance on any form or agreement bearing my signature pursuant to this authorization.

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