Applicant Information

NOTE: If you are using a route or P.O. Box number, please also give the street address. If no street address is available, please give the name of the nearest street.

Spirit is not available in MA, MD and WA.

Please only enter a single email address.

Please enter the General Agency Name.

Please enter the name of the agent.

Don't know your NPN? Click here to search.

Agency Information

Please only enter a single email address.

NOTE: If you are using a route or P.O. Box number, please also give the street address. If no street address is available, please give the name of the nearest street.

Assignment of Commission
Assignee Information
Bank Information (Direct Deposit)

NOTE: Checks need to accrue to a total of $25 and direct deposit will need to accrue to a total of $5 before the commissions are issued. Your check will be deposited the second working day of each month and your statement will be sent via U.S. mail the second working day of each month.

Additional Information

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.

Questionaire