Agent Contracting Form 2023

Simple Choice -- Contracting Form

Welcome to Simple Choice and our upline Spark’s contracting form.

We want to make this process as seamless as possible for you. Please follow the instruction below.

If some questions appear repetitive, it’s because we’ve consolidated questions that are asked across many carriers! It should take no more than 15 minutes to complete. 

After completing the form we will follow up to provide you access to our Platform where you can: 

  1. Track your contracting status and determine next steps
  2. Update your marketing profile, access the Spark CRM, and continue with the rest of onboarding

We look forward to working together! If you have any questions, please don’t hesitate to reach out to your Strategic Growth Manager or email

(As it appears on your license)
This is the email we will use for all correspondence with you.
If you don't know, write "Don't know"; if direct, write "Simple Choice"

If you don't know your NPN number, you can search for it here: Please enter your first name, last name, and NPN number as it appears on NIPR.


Medicare Advantage Contract Requests

Select the carriers that you would like to be contracted with (please discuss this with your Agency Principal and/or Strategic Growth Manager ).

Please be advised that some carriers charge resident and-or non-resident appointment fees, as indicated below. If you are requesting one of those carriers (e.g. UHC, Anthem), we will ask the states you'd like to be appointed with.

Your Personal Information

Format: m/d/Y e.g. (4/21/1998)

Business Information

If you don't know it, search on NIPR using your FEIN number.

State Selection

New or Transfer

Agent Questions... Almost Done!

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