PROSPERITY LIFE

PROSPERITY LIFE CONTRACT REQUEST
Prosperity Life Final Expense

Prosperity Life Final Expense (105% Commission)
Also Send Contracting For

SBLI (Savings Bank Life Insurance) (80% Commission) Transamerica (Term Life With Living Benefits) (80% Commission) Gerber Life (Grow Up and College Plans) (60% Commission) AIG (Guaranteed Issue Whole Life) (80% Commission)
Full Name As Appears On Your License *

First Name Middle Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Information
E-mail Address *
youremail@youremail.com
Phone Number *

Area Code Phone Number
Tax ID Number
Federal Tax ID Number: *
Social Security Number 345-45-4545 or Federal Tax ID Number: 38-2345676
Tax ID Type *
Name of Business if using a Business Federal Tax ID Number
Upload a signed W-9 Form if using a Federal Tax ID Number
Licensing Information
NPN *
987654321
Thank you for requesting a PROSPERITY LIFE INSURANCE GROUP FINAL EXPENSE CONTRACT. We are certain this will be a great addition to your product portfolio. Click the CONTINUE TO CONTRACTING BUTTON to be directed to the Contracting login Page.

Important Note: When completing your contracting the first thing you will be asked is "Are you an Agent or Agency?". If you want commissions paid to a TIN# select "Agency". If you want commissions paid to a SS# select "Agent".
Broker Contracting, (901) 221-8834, Email: tweis@mycoreinsurance.com
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PROSPERITY LIFE CONTRACT REQUEST