Wholesaling Opportunities Form

Wholesaling Opportunities Form
If you would like more information about joining the AIP Marketing Alliance, please complete the
fields below and we will contact you once your application has been reviewed. Thank you!
(*required fields)

*company name:

*first name:

*last name:

*work phone:

*fax:

*email:

*street address:

*city:

*state:

*zip code:

What percentage of your current agency production comes from: % personal production % wholesale production

Current Downline: How many agents are in your wholesale hierarchy?
How many agents personally produce out of your office?

What states are you currently licensed in? (please list)

CURRENT PRODUCTION:

Traditional Fixed Annuities:
annual premium
companies used

fixed Indexed Annuities:
annual premium
companies used

Term Life :
annual premium
companies used

Universal and Whole Life:
annual premium
companies used

LTCi:
annual premium
companies used

Securities:
annual GDC
broker dealer

I am interested in:

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