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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 Insurance License. 

2. National Producer Number (NPN).

3. States you want to get appointed in:

           TX, FL, CA, SC, LA, MS, TN. 

4. Companies you want to get appointed with:

           Molina, Ambetter, BCBS, OSCAR, Humana

           Wellcare, Cigna.