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Contract Online

We know that independent agents are busy people. Avoid printing, faxing, and mailing with online contracting.

If you have any questions about contracting through us, call 877-255-0284 to speak to an Medicare Advisors marketing specialist.

2026 AGENT ONBOARDING

Agent Contract Application

One polished, guided application for contracting, licensing, documents, signature, and carrier selections.

✓ 9 guided sections ✓ Secure document upload ✓ Mobile friendly
✓ Protected submissionEncrypted data & documents
APPLICATION PROGRESS Contract Application
Step 1 of 911%
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Your privacy matters. This application contains sensitive financial and licensing information. Submit only from a trusted device over HTTPS.
1
SECTION 01

Contract Application

Tell us about you and your agency.

Sex

Residential Address

U.S. residential address format

Business Address

Complete if applicable

Mailing Address

Where should we send mail?

Previous Address

Complete this only if you had another address within the last 10 years.

Contact Information

Preferred Method of Contact (select all that apply)
2
SECTION 02

Banking Information

A voided check must be uploaded in Step 8.

Banking Information

Encrypted at rest

Other Information

3
SECTION 03

AML & FINRA

Complete the Anti-Money Laundering and FINRA registration information below. Both Yes / No questions are optional.

Anti-Money Laundering (AML)

Course status optional
Have you taken an AML (Anti-Money Laundering) course within the past two years? (Optional)

FINRA Registration

Optional
Are you a Registered Rep with FINRA? (Optional)
4
SECTION 04

Background Information

Make sure to provide an explanation for all "YES" answers provided below.

Is there any indebtedness to any insurance company? *
Have you ever been convicted of a felony or misdemeanor other than a traffic offense? *
Have you had your driver’s license revoked? *
Are you now, or have you ever been, employed by or associated with a bank, savings and loan, or other financial institution? *
Are you now subject of any complaint, investigation, or proceeding which could result in a yes answer to any of the preceding questions? *
Have you ever been refused a bond or Errors and Omissions Insurance? *
Have you ever had your insurance license suspended or revoked? *
Have you ever had disciplinary action taken against you with any Department of Insurance? *
Are you now, or have you been within the past five years, involved in any civil litigation, judgments, liens, or foreclosures? *
Have you ever been denied an appointment with any insurance company? *
Have you ever been terminated for cause by any insurance carrier? *
5
SECTION 05

Bankruptcy & Letter of Explanations

Complete the bankruptcy information first, then add formal action explanations when applicable.

Bankruptcy Information

Required Yes / No
Are you in the process of, or have you ever, filed for bankruptcy? *
Have you ever filed bankruptcy, been declared bankrupt or insolvent, or had your salary garnished? *
Have you, or any business of which you were or are a principal, been involved in a bankruptcy action or compromised liabilities with creditors? *
Have you ever filed a petition for bankruptcy or for protection from creditors? *
Has any insurance or securities brokerage firm with which you were associated ever filed a bankruptcy petition or been declared bankrupt during your association or within 5 years after termination? *
Bankruptcy Details
Letter of Explanation

Action 1

Optional

Action 2

Optional

Action 3

Optional
6
SECTION 06

Agent Referral

Optional — refer agents and help grow the Medicare Advisors team.

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7
SECTION 07

Carrier Selection

Select each carrier and add non-resident appointment states when needed.

Carrier AppointmentsSearch by carrier name or the state guidance supplied by Medicare Advisors.
State guidance: Availability notes shown below reflect the carrier list supplied by Medicare Advisors on September 10, 2026. If no state note is displayed, no state guidance was included in that list.
Appointment fee notice: Some carriers may charge resident and/or non-resident appointment fees.

Carrier selection complete

  • Review the carriers and requested non-resident states you selected.
  • Continue to Step 8 to upload supporting documents.
  • Step 9 is the final Signature Authorization and submission.
8
SECTION 08

Supporting Documents

Upload the documents needed to process your appointment.

Accepted: PDF, JPG, JPEG, PNG. Files are encrypted before storage. Insurance License is required and supports up to 50 files for multi-state licensing.
9
SECTION 09

Signature Authorization

Final step — review the authorization and sign in the box.

GENERAL AGENT: MEDICARE ADVISORS INSURANCE GROUP LLC

I hereby authorize Medicare Advisors to affix or append a facsimile of my signature, as set forth below, to all required signature fields on all Insurance Carrier documents through the software or through any other means, including without limitation, by e-mail or orally. For which I have authorized Medicare Advisors Insurance Group LLC to submit all such forms and agreements on my behalf, for the purposes of being Contracted to sell products of Carriers through Medicare Advisors Insurance Group LLC. I hereby release, indemnify and hold harmless Medicare Advisors Insurance Group LLC against any and all claims, demands, losses, damages, and causes of action, including: expenses, costs and reasonable attorneys’ fees, which they may sustain or incur as a result of carrying out the authority granted hereunder.

I affirm that the information I have submitted through the interview process to Medicare Advisors Insurance Group LLC is correct to the best of my knowledge and acknowledge that I have read and reviewed the documents for which I am authorizing my signature to be affixed to. I acknowledge and agree to indemnify and hold harmless any third party from and against any and all claims, demands, losses, damages, and causes of action, including: expenses, costs and reasonable attorneys’ fees, which such third party may incur as a result of its reliance and acceptance on any form or agreement of a facsimile of my signature.

By signing this form, I acknowledge that all information is true and correct to the best of my knowledge.

Draw your signature *
Use your mouse, trackpad, finger, or stylus.

Get Contracted

With over 17 years experience, we serve over 500 active agents in all 50 states providing the highest level of back office support to individual agents as well as agencies across the United States.

We bridge the gap between agents and carriers allowing you to focus on sewing your clients rather than wasting time with administrative activities.

We provide in-depth product and service knowledge to keep you informed and well-prepared to meet your clients’ needs. And each year we reward you, the top producers, with an annual producers convention in exotic, beautiful locations!

Products & Carriers
  • Medicare Advantage
  • Supplemental Insurance
  • Part D
  • Life Insurance
National Coverage