Contracting Request 4T Brokerage / Contracting Request Get Contracted (1) "*" indicates required fields Step 1 of 3 33% Carriers Requested* AARP United Healthcare O65 Aetna Continental Aetna Coventry Aetna U65 Aflac AIG American General Life Allied National Ambetter American General Final Exp American National Ameritas Anthem Amerigroup Ascension under 65 Assurity Banner Bestow Life Blue Cross Blue Shield Blue Cross Blue Shield Illinois Blue Cross Blue Shield of Texas Caresource CCA Commonwealth Care Alliance Cigna MedSupp Cigna Healthspring MAPD Cigna Under 65 Clear Spring Clover Delta Dental Devoted Health Plans Encompass Envision RxPlus Florida Blue MAPD Foresters Freedom Optimum Health GeoBlue Gerber Life Great Western Insurance Company Guarantee Trust Life Insurance Health Alliance Plan Humana Icare Illinois Mutual Dental Vision Life Illinois Mutual IMG Travel John Hancock Kaiser Lasso Life Secure Lincoln Lumico Manhattan Life Medi Share Medico Midland National Minnesota Life Securian Molina Health Molina Medicare Mutual of Omaha National Care Dental National General Medical Allstate North American Life OneShare Oscar Pacific Life Pekin Philadelphia Life Physicians Health Plan Physicians Mutual Medicare Pivot Health Priority Health Prosperity Life Protective Prudential Renaissance SBLI Sentinel Security Simply Healthcare SureBridge Superior Dental Solutions The Health Plan TransAmerica UBA United Health One United Healthcare U65 United National Life United of Omaha Insurance WellCare Meridian Zing For AARP United Healthcare O65 which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Aetna Continental which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Aetna Coventry which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Aetna U65 which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Aflac which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For AIG American General Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Allied National which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Ambetter which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For American General Final Exp which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For American National which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Ameritas which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Anthem Amerigroup which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Ascension under 65 which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Assurity which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Banner which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Bestow Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Blue Cross Blue Shield which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Blue Cross Blue Shield Illinois which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Blue Cross Blue Shield of Texas which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Caresource which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For CCA Commonwealth Care Alliance which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Cigna MedSupp which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Cigna Healthspring MAPD which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Cigna Under 65 which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Clear Spring which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Clover which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Delta Dental which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Devoted Health Plans which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Encompass which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Envision RxPlus which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Florida Blue MAPD which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Foresters which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Freedom Optimum Health which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For GeoBlue which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Gerber Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Great Western Insurance Company which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Guarantee Trust Life Insurance which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Health Alliance Plan which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Humana which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Icare which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Illinois Mutual Dental Vision Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Illinois Mutual which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For IMG Travel which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For John Hancock which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Kaiser which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Lasso which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Life Secure which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Lincoln which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Lumico which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Manhattan Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Medi Share which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Medico which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Midland National which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Minnesota Life Securian which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Molina Health which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Molina Medicare which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Mutual of Omaha which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For National Care Dental which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For National General Medical Allstate which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For North American Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For OneShare which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Oscar which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Pacific Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Pekin which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Philadelphia Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Physicians Health Plan which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Physicians Mutual Medicare which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Pivot Health which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Priority Health which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Prosperity Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Protective which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Prudential which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Renaissance which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For SBLI which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Sentinel Security which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Simply Healthcare which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For SureBridge which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Superior Dental Solutions which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For The Health Plan which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For TransAmerica which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For UBA which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For United Health One which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For United Healthcare U65 which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For United National Life which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For United of Omaha Insurance which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For WellCare Meridian which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB)For Zing which type of contract are you requesting?NEW CONTRACT - (I’ve never been contracted with this carrier)TRANSFER CONTRACT - (I’m contracted with this carrier under a different agency and want to move to 4TB)DIRECT CONTRACT - (I’m contracted directly with this carrier and want to move to 4TB) First Name*Last Name*Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code National Producer Number (NPN)*Don't have it? Find your National Producer Number here.Are you an agent currently contracted with 4TBrokerage?*NoYesHow will your commissions be paid?*Direct Pay (paid directly by the carrier)Agency (assign commissions to an agency)LOA (assign commissions to my upline)If you were referred to us, let us know the agent/agencies name:SSN*Agency EIN (if applicable)Agency Name (if applicable)Agency NPN (if applicable)