ePro Associates Spot – Pinnacle Financial Services

Complete this form and receive your requested carrier contracting link today!

Quicker Processing Time Simplifies and Reduces Delays Complete your Appointment Information in Minutes

Fill out the form as it auto-populates to fulfill carrier requirements. If you have any questions, please contact licensing at 1 (215) 395-8492 or contracting@eproassociates.com.

Is this for an Agent or an Agency? *

Agent
Agency

* Fields with asterisks are required by carriers.

Agent NPN *

Desired Carriers *

ACI
Aetna Coventry
AIG/ Corebridge
Aflac
Alignment
Allstate/ National General
Anthem
Atlantic Coast Life
Atlantic Med Supp
BayCare
BCBS MI
Capitol Life
CarePartners
Cigna HealthSpring
Clover Health
Devoted Health
Emblem
Forresters Financial/ Foresters Life
Florida Blue
Freedom
GlicRx
Health First
Humana
Independence Blue Cross
Lumico/ USIC
Molina MA
Mutual of Omaha Med Supp
Mutual of Omaha PDP
National Care Dental
National Life
NGL/ MS
Optima
Prosperity Med Supp
SCAN
Select Health
Sons of Norway
Ultimate
UnitedHealthcare
United Home Life
United National Life
WellCare/ Centene/ Healthnet

* Fields with asterisks are required by carriers.

ATTENTION: If you are requesting to contract with GLIC Rx, please remember to download and sign the GLIC Rx Compliance Page as well as the W9 Form to submit via email to our sales team, at sales@pfsinsurance.com.

Contracting for GLIC Rx can not be processed without the compliance page.

Agent Name *

First

Last

Corporation Name *

Email *

Agent DOB

Phone *

Is this a mobile number? *

Mobile Phone *

By submitting your phone number you give permission to receive text communications from Pinnacle Financial Services. Message and data rates may apply.

Text Notification Agreement *

I agree

Address *

Address Line 1

Address Line 2

City

State

Zip Code

State(s) to Sell

Upline Agency Affiliation

Please send me a link/ contract for the companies listed.

Agent Social Security Number *

Corporation TID *

Corporation NPN *

Message

Signature *

Clear Signature

Phone