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Click Here to download the Premier Insurance Contracts Inc New Agent Contracting Form or fill out the Form Below with the Following Information : 

1. Name as it appears on your Texas Department of Insurance License 

2. National Producer Number (NPN)

3. States you want to get appointed in 

  TX  FL CA  SC  LA  MS 
Molina   X X X X   X
Ambetter  X          
BCBS  X          
Oscar  X          
CHC  X          
Humana  X          
Wellcare  X       X  

4. Companies you want to get appointed with