Full Name

Email *

Phone *

Which state do you hold an active resident life insurance license? *

What is your NPN number? *

List all states that you have an active life insurance license in *

Do you primarily sell life insurance through tele-sales or face-to- face? *

Tele-sales

Face to Face Sales

How long (in months) have you actively been selling life insurance? *

What is your total annualized premium (AP) issued in the last 3 months? *

What is your average monthly placement rate (issued policies vs. submitted)? *

What is your average monthly persistency rate (% of policies that stay on the books)? *

Who is your current upline? *

Which final expense carriers are you currently appointed with? *

Have you ever been terminated by a carrier for unpaid chargeback debt? *

Yes

Do you currently have more than $3000 in cash or available credit (liquidity) to pay for a chargeback if it occurs? *

Yes

Do you have any outstanding chargeback debt with any carrier? If so, please provide which company and how much you owe.

Please upload a screenshot or pdf your most recent credit score (docuent must have your name somewhere on the document). Suggested sources of credit scores: creditkarma.com and most major cedit cards. *

📢 Address is used to preform a Vector One Check

Street Address *

City *

State *

Postal code *

📢 This will be used to preform a Vector One check.

Social Security or EIN Number (If your carriers pay to your personal name, use Social Security. If the carriers pay your business, use EIN number) *

Agree and Consent *

I agree

By submitting this form, I certify that the information provided is true and accurate to the best of my knowledge. I authorize Alpha Theory Insurance to contact me via phone, email, or text regarding this opportunity. Message frequency varies. Message & data rates may apply. You can reply STOP to unsubscribe at any time. Your information will be kept confidential and used solely for internal screening and contracting purposes. We do not sell or share your data with third parties. I understand that completing this form does not guarantee a position or carrier appointment.

⚠️After you click submit, you will be redirected to sign a Vector One form.