4. Sole Proprietor application

Sole proprietor

Sole proprietor application

Thank you for your interest in joining us as a sales partner! Please use the form below to apply for contracting if you are a licensed agent doing business independently.

If you are seeking a contract for your agency and will have more than one licensed agent, see the new agency (brokerage) form. If you are seeking appointment through the account of an agency or brokerage that has an existing contract, see our agent appointment form.

Our sales leadership team review all applications for new contracts. If approved, your contract will go into effect the month you submitted your application.

Required attachments to upload with application

  • W-9
  • EFT authorization form
  • Check or other bank document
  • Declarations page of current Errors & Omissions policy
  • State insurance license(s)

 Have questions or need help? Email us at agentlicensing@deancare.com or call us toll-free at 877-317-3046

Application form

 *Required

Example: languages spoken
Please provide additional information to help us determine if our partnership will be an effective one, such as background of agency, mission statement, geographic location(s), and sales history and expectations.
Please answer the following questions truthfully and completely. Please include an explanation of any "yes" answers in the text box provided below.
Please include dates, persons and government entities involved, and attach relevant documentation, such as court decrees or findings of investigation.
Please use a mouse or your finger to sign your name in the box above.

Have you attached all the proper documents to this application? Your application will not be processed without all of the proper documentation that is needed with this request.