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Agent Information

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Agent Application

First Name

Birthday

National Producer Number (NPN)

Phone

DOI

Last Name

Social Security

Email

Address

License Type

Will you report to any sub agency?

What lines of business do you want to Contracted?

Medicare

ACA

Life & Annuities

Anxiliares

Medicare Contracts:

Humana/Careplus (Popular)

Simply (Popular)

Devoted (Popular)

Wellcare/Centene (Popular)

United HealthCare (Popular)

Cigna

Aetna (Popular)

Freedom/Optimum (Popular)

Florida Blue

Ultimate

Health Sun

Solis

Gold Kidney

All Medicare Carriers

Life Products:

Ameritas Dental & Vision

Washington National

ACA Products:

Ambetter

Molina

Oscar

United HealthCare

Aetna

AvMed

Cigna

Friday Health Plans

All ACA Products

Life Products:

Ameritas Life

Baltimore Life

Foresters

Gerber

Great Western

United Of Omaha (Mutual Of Omaha)

National Life

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