Follow the steps to successfully complete your application

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the appropriate box for the license you are requesting: Resident License or Non-Resident License.
3. Identify your home state by filling in the corresponding space and enter your home state license number if applicable.
4. Provide your business entity name, along with the FEIN (Federal Employer Identification Number), and, if assigned, the National Producer Number.
5. List any other assumed, fictitious, alias, or trade names under which your business is operating or intends to operate.
6. Indicate the state of domicile and provide information regarding affiliation with any financial institution or bank.
7. Fill in your business address, including city, state, and zip code. Ensure to enter the phone and fax numbers as well as the business website and email address.
8. Designate at least one responsible licensed producer by providing their name and social security number.
9. Identify all owners, partners, officers, and directors of the business entity, including their names, titles, social security numbers or FEIN, and ownership status.
10. Complete the section regarding jurisdiction and type of license/registration requested by checking the relevant options across the provided sections.
11. Carefully read the background information questions and provide accurate responses, attaching necessary documentation where required.
12. Complete the certification and attestation section, ensuring all information is true and complete, and acknowledge your understanding of the insurance laws and regulations.
13. Gather and attach any required documents, as specified in the attachments section, to avoid delays or deficiencies in processing.
14. Upon reviewing all completed fields and attachments, save changes, download, print, or share your completed form as necessary.

Begin the application process online today and ensure your business is properly registered.