Agent Signup
Fill out this form to create a username and profile for yourself.
 
Name   
Company Name
Address
       

     Contact Information
 
Phone Number
Fax Number
E-Mail Address

     Login Information
Select an original username. If your desired username is not available, you will be prompted for a different one. When your registration is complete your password will be e-mailed to the address you have entered above.
 
Username  
Password
Re-type Password
 
     About Your Business
 
In which state do you have your resident license?
Which types of products do you currently sell? (Check all that apply)

Annuities
Life Insurance
Long-Term Care
Disability Income
Medicare Supplement
Securities

Which of these areas is your primary source of income?

Annuities
Life Insurance
Long-Term Care
Disability Income
Medicare Supplement
Securities

How much fixed and indexed annuity premium did you issue in the last 12 months?
How much GDC did you do in the last 12 months?
Which securities licenses do you currently hold? (Check all that apply)

Series 6   Series 24
Series 7   Series 63 
Other:

Who is your current broker/dealer?  
How did you hear about Ann Arbor Annuity Exchange?  
Which Ann Arbor Annuity Exchange offerings would you like to hear more about? (Check all that apply)

Annuities
Life & LTC
Broker/Dealer Services
Prospecting Programs
Incentive Programs
Other:

 
     Terms of Use
 
    By checking this box, I certify the following:
  • I understand that by providing the fax number and/or email address above, I hereby consent to receive faxes and/or emails in regards to business sent by or on behalf of Ann Arbor Annuity Exchange.
  • I am a licensed insurance producer (or work with licensed producers or directly for a licensed company).
  • I understand that the information on this site is for producer use only.
  • I agree not to disclose any of this information to the public.
  • I understand that not all of the products and strategies shown on this website are available in every state.
  • I have read and reviewed the Terms and Conditions.
 I Agree
 
     Confirm and Submit
Once you have filled out all the fields above, click on the Create User button to submit your signup and gain access to our website.
 

 
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