Are you an Officer or Owner of
this Agency ? | *Please enter your Producer# Required Invalid | *Your Agency Name
(*Enter your name if not applicable)
Required |
Please choose a password Password must be: 8-12 characters in length, contain an upper case letter, contain
a lower case letter, contain a number and contain a special character ($@!%*?^). |
*Your E-mail Required Invalid | *Password | *Re-enter Password Required Password & Confirm Password should be same |
| |
Please select a hint question from the below dropdown, and provide an answer
for it . This will help us to verify your identity in the future if you forget your
password. |
*Hint Question Required | *Answer Required | |
Contact Information |
*First Name
Required | *Last Name Required | *Address Required |
*ZIP Required | *City Required | *State Required |
*Telephone Required Invalid | Fax Invalid | |
*Type of Business
| *Tax ID(#########)
[Exclude dashes] Required Federal ID must contain 9 digits. | *Social Security # (#########)
[Exclude dashes]
Required |
License Information |
*License Number (e.g. LA-123456)
Please enter your full license number in the following formats:
- BR-XXXXXX
- LA-XXXXXX
- LB-XXXXXX
- PC-XXXXXX
Required | *License Issued State Required | *License Effective Date Required MM/DD/YYYY |
*License Expiry Date
Required MM/DD/YYYY Expiry date should be greater than current date. | Attach a copy of the license Please select a valid file |
Terms & Conditions
I am submitting this online producer account application to establish an administrative
account with ShelterPoint Life Insurance Company and all of its subsidiaries (collectively referred to as "ShelterPoint"). The information submitted is accurate and true to the best of my knowledge,
and I am creating this administrative account for my use in:
- Submitting DBL applications and updating account information.
- Downloading and viewing applications, statements, forms and license information.
- Checking the status of commission payments and premium payments made by me, my agency
or the insured.
Licensed agents or brokers in my employ may have access to this account only after
I have provided ShelterPoint with the name and license number of the licensed
agent or broker in my employ, or affiliated with my agency or brokerage, who will
have such access. Once I have provided ShelterPoint with each user’s information
I must establish a separate account for each agent’s or broker’s use.
I acknowledge that I must maintain this account by adding or deleting users and
must ensure the validity of the users on my account. If a designated user leaves
my employ or ceases affiliation with me, I must delete that account and notify ShelterPoint of the inactive status. Failure on my part to maintain this account and
ensure the validity of users may result in termination of this online account and
other actions by ShelterPoint.
ShelterPoint retains the right, in its discretion to cancel any account or user access for misuse
of this site or any downloaded applications and forms. As the primary user on this
account, I am responsible for each user’s access and activity, and will be liable
for any costs or other penalties associated with their use of this account.
I understand that my use of this website and the services available through this
website are optional, and by clicking “Accept”, I agree to comply with the Terms
of Use and the conditions set forth above.
Required |
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*Enter the letters as they are shown in the image above.
(Letters
are not case-sensitive) Required |
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