Training Platform and Contracting Request Form

Agent Information

Recruit's First Name *

Recruit's Last Name *

Recruit's NPN (National Producer Number) *

Email *

Phone *

Recruit's License Type: *

Recruit’s Resident State Life Insurance License *

Recruiter Information

Recruiter Name (Your Full Name) *

Recruiter Email (Your Email) *

Recruiter Phone (Your Phone) *

Recruiter NPN (Your NPN) *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

What Happens Next

Once submitted, Your Agent will receive a "Onboarding Packet” directly to their email that you provided. - Have them complete the "Onboarding Packet”. This will happen within 1-3 business days.

Your Agent receives access to all “Impact Resources” followed by an email with contracting invitations for the carriers/ product affiliated with your agency. - Walk them through the resources and ensure they complete their carrier contracts

Impact's Contracting Team receives all completed contracts, processes and sends them to the carrier for final approval and a writing number. - Connect to the Impact community and continue training.

You will receive an email from the individual carrier with their writing number and login information to their specific carrier portal.