Agent Contracting Form

Simple Choice Contracting Form

We're excited to have you join Simple Choice!

Please complete this onboarding form so that we can submit documents on your behalf and make the contracting process seamless. If some questions appear repetitive, it's because we've consolidated questions that are asked across many carriers! It should take no more than 10 minutes to complete if you have the information below on hand. 

An Agent Success associate will be in touch shortly after completion.

If you plan to contract with a Medicare Supplement company, please have your NPN number, a copy of your E&O insurance, and a copy of a voided check ready.

Don't know your NPN number? Look it up here:
Select agency if you have downline agents.

Contract Requests

Select the carriers that you would like to be contracted with (please discuss with your upline or Strategic Growth Manager if you aren't sure).

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), note which states you'd like to be appointed with in the "additional information" section below.

If not, you can purchase discounted E&O at this link:

Lastly, to show our excitement about you joining the SCIB team, please enjoy a small gift from us. Enter your shirt size & type, and you can expect a box to arrive at your home address in the next 2 weeks!