WHOLESALE DISTRIBUTORS

Thank you for your interest in AIP Marketing Alliance. Please complete the fields below. One of our Business Development team members will contact you shortly to review your application.

(*required field)

First Name*
Last Name*
Email*
Address*
Address 2
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 licensed in? (please list)

Current Production

Fixed 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 Premium
Companies Used

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