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Wholesaling Opportunities Form
If you would like more information about joining the AIP Marketing Alliance, please complete the
fields below and we will contact you once your application has been reviewed. Thank you!

(*required fields)

*company name:
*first name:
*last name:
*work phone:
*street address:
*zip code:
What percentage of your current agency production comes from:
% personal production % wholesale production

Current Downline:
How many agents are in your wholesale hierarchy?
How many agents personally produce out of your office?

What states are you currently licensed in? (please list)
Traditional Fixed Annuities:
annual premium

companies used
fixed Indexed Annuities:
annual premium

companies used
Term Life :
annual premium
companies used
Universal and Whole Life:
annual premium
companies used
annual premium
companies used
annual GDC
broker dealer
I am interested in:
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