Please only enter a single email address.
Select the states in which you would like to be appointed. Please provide
your license numbers for each respective state.
NOTE: If you are licensed and wish to sell in PA, you must be appointed prior to solicitation.
NOTE: Errors & Omissions Insurance is required to complete your application.
If you are unable to upload the summary page of your E&O there
are a couple options: This can either be sent by email to
or by fax to (651) 649-3502.
Has Authorized Representative /Agency / Agent ever: