Sole proprietor

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Sole Proprietor application

Use this form to apply for contracting if you are a licensed agent doing business independently.

If you are seeking a contract for your agency and will have more than one licensed agent, please see the New Agency (Brokerage) form. If you are seeking appointment through the account of an agency or brokerage that has an existing contract, please see our Agent Appointment form.

Our sales leadership team meets monthly to review all applications for new contracts. Applications are due by the first of the month, and you will be notified of the decision by the 15th. If approved, your contract will be effective the first of the following month. The contracting period closes each year during the fourth quarter.

Required attachments to upload with application

Have questions or need help? Email us at or call us toll-free at 877-317-3046

Application form


**We partner with these Field Marketing Organizations for Medicare sales. Check the one that applies.
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