Broker Appointment

Step 1 of 4

For General Agencies, Agencies, and Agents/Producers
Complete the Broker Appointment Profile below (5-7 minutes to complete) and execute the Agreements and Authorizations via electronic signature. If you get interrupted in the middle of completing the Profile, click on the Save and Continue Later button and you’ll receive a link to securely finish your Profile at a time that works best for you.

Once you have executed the Agreements and Authorizations via electronic signature, please upload your executed W-9 Form and we will get your Contracting processed within 2 business days (or as soon as administratively feasible) of having ALL of the executed Contracting Documents in our possession.

Please note:
  • General Agents should Contract prior to having any Agencies or Agent’s Contract. Once contracted, you will receive a unique link that will enable your Agents and Agencies to complete this same process with you tied to the business
  • Agencies will follow the same protocol to ensure proper credit for Agent appointments
Upon receipt of all required documents, you will receive the Commission Agreement for execution which will finalize your Contracting Process.
Thanks for your interest in Xpress! We look forward to serving you!
Contracting Type
Tell us a little bit about your business and how you conduct business so we can set up your appointment documents properly. It will only take a couple minutes to prepare all of the documents you need for your appointment!
Type of Contracting
General Agency: Large MGA/FMO with over 500 Agents and benefit production over 50,000 members per year.
Agency: Agency with multiple Agents to be separately contracted.
Commission Assignment
Many GA's and Agencies require commissions to be assigned to them and they, in turn, will pay you - it may be tied to additional bonuses or compensation to you. If your commissions are assigned, you will need to execute the Assignment Form as part of this Broker Contracting process.
Referred By
We'd love to know who was your champion so we can thank them personally!
Primary Contact
Please give us the information for the primary person authorized to execute contracts on behalf of your business - whether you're an individual agent or the Agency Principal.
Enter Your 9-digit Identification Number including your SSN, Visa, Green Card, etc.
Address
If you're the Agency Principal, you can use your business address here; if you're an Independent Agent working on your own or within an Agency, use your home address here.
After you complete the Broker Appointment Profile above, upload your W-9 to ensure timely payment of your commissions:
  • Once your Profile above is complete and click the Submit button, you will be asked to review and securely execute the Xpress Agreements via electronic signature.
  • Once completed, Download the W-9 Form to your local drive
    • For further instructions, call us at 215-485-5217
  • Once you’ve executed the W-9 Form, upload your file using the Upload Feature to the right.
  • If you are having deposits made via ACH, please upload a copy of a voided check for the account your entered using the Upload Feature to the right.
  • Once your Broker Appointment Profile  is complete, Agreements executed, and you submit the W-9 for review, we will begin processing your Contracting.

Contact broker@xpressenrollment.com or call us at 215-485-5217 if you have any questions or trouble with downloading or completing the Broker Appointment forms.

Upload File
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