This form is for experienced insurance brokers and agents or producing financial advisors looking for an independent office set up or to work at one of our office locations selling insurance and securities product to your clients. Our independent broker program is best for persons with a successful current business, existing customer contacts of some kind or a professional background with a plan for success.

Agents who sell annuities, life policies and other product are welcome to see how we can help.

Series 7 Sponsorship and Series 24 Sponsorship is available to qualified people with a plan for their insurance agent success as an independent or working at an office.

Current licensed brokers and groups who want to become independent broker representatives are welcome.

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Name:
State:
E-mail:
Telephone:

Goal:	Open a branch office of our firm Work at an established firms office
Are you Series 7 Licensed:	Yes No
How long have you been Series 7 licensed?:	Less than 1 yr 1 yr - 5 yrs 5 yrs +
Current Clients:	I have Insurance clients I have no Insurance or Professional clients
Money Under Management:	0 - 100,000 100,000 - 200,000 200,000 - 500,000 1 - 2 Million 3 Million +

What other Licenses or Designations do you have?

Comments:

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