New agency (brokerage)
New agency application
Thank you for your interest in joining us as a sales partner. Use this application to apply for a contract and establish an account to appoint multiple agents under your agency.
If you are seeking an appointment through the account of an agency or brokerage that has an existing contract, see our agent appointment form. If you are a sole proprietor or independent agent, see our sole proprietor form.
Our sales leadership team reviews all applications for new contracts. If approved, your contract will go into effect the month you submitted your application.
Required attachments to be uploaded with application
- W-9 (PDF)
- EFT Authorization form (PDF)
- Voided check or other bank document for commissions payment
- Declarations page of current errors & omissions policy
Have questions or need help? Email us at agentlicensing@DeanCare.com or call us toll-free at 1-877-317-3046.
Application form
* Required