Boost Your Career with Dedicated Insurance Advisors

YOUR OPPORTUNITY STARTS TODAY

+1-832-342-0894
office@dinsuranceadvisors.com
Monday–Friday | 9:00 a.m.–6:00 p.m.

STEP 1 OF 3: Contact & Licensing Information

Tell us about yourself and the partnership opportunity you are seeking:

Full Name*

Phone*

Email address*

NPN (if available)

ZIP Code*

States Where You Are Currently Licensed (if available)

STEP 2 OF 3: Products & Contracting Interests

Select the products and benefit solutions you are interested in offering:

Select all that apply:

Medicare — Medicare Advantage, Medicare Supplement and Prescription Drug Plans (PDP)
ACA Marketplace Health Insurance
Private Health Insurance Under Age 65 — Including Short-Term Medical
Employer-Sponsored Health Insurance and Group Benefits
Life Insurance and Wealth Protection — Term, Whole Life, Final Expense and IUL
Annuities and Retirement Solutions — Tax-deferred growth, principal protection, guaranteed income options and legacy planning
Supplemental and Ancillary Insurance — Hospital, Cancer, Accident, Critical Illness, Short-Term Care, Dental, Vision and Hearing
Health and Lifestyle Membership & Discount Plans — Telemedicine, Dental, Vision, Prescription, Pet Care and Everyday Savings
I’m Not Sure — I Would Like Guidance From DIA

ARE YOU INTERESTED IN A SPECIFIC CARRIER OR PRODUCT?

Please provide the carrier or product name.

STEP 3 OF 3: Final Details & Submission

Provide any remaining information and submit your request to our contracting team:

Current Upline or Broker (if applicable)

How Did You Hear About DIA?

Additional Information (optional)

SECURITY NOTICE: During the formal carrier contracting process, additional information may be required, including a Social Security Number or EIN, tax information, and banking details. This information is not collected through this initial form. If required, it will be submitted later through secure and authorized contracting platforms.

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Boost Your Career with Dedicated Insurance Advisors

YOUR OPPORTUNITY STARTS TODAY

agent and agency partnerships