• Applicant Information

  • Date Format: MM slash DD slash YYYY
  • Please only enter a single email address.
  • Please enter the General Agency Name.
  • Please enter the name of the agent.
  • Don't know your NPN? Click here to search.
  • Agency Information

  • Please only enter a single email address.
  • Assignment of Commission

  • Assignee Information

  • Please only enter a single email address.
  • Bank Information (Direct Deposit)

    NOTE: Checks need to accrue to a total of $25 and direct deposit will need to accrue to a total of $5 before the commissions are issued. Your check will be deposited the second working day of each month and your statement will be sent via U.S. mail the second working day of each month.
  • Errors & Omissions Insurance

  • Date Format: MM slash DD slash YYYY
  • Agent/Agency License

  • NOTE: Files must be smaller than 1MB. A copy of your agent licensing (and agency if applicable) and a copy of your E&O is REQUIRED complete your application. If you are unable to upload copies of these, you may also email it to agentsupport@directbenefits.com or fax it to (651) 649-3502.

    MWG will appoint agents in each state(s), as they sell their first case in that state, and its confirmed that their license is an active and valid license.
  • Questionaire

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