Agility - Open Enrollment

Agent or Agency

Are you contracting as:

Agent

Agency

Personal Information

First Name *

Last Name *

NPN (National Producer Number) *

Date of Birth *

Email Address *

Phone Number *

States

In which markets do you sell?

Assignee

Are you paid commissions directly, or do you assign your commissions to an agency?

I get paid directly

I assign my commissions

Additional Notes

Communications Opt-In:

By opting in, you consent to receive calls, text messages, and/or emails from or on behalf of Agility Insurance Services, which may be delivered using automated systems, including AI-generated or prerecorded voices and automated dialing technology, to the number(s) and email address you provided. You may opt out of marketing communications at any time by replying “STOP” or by contacting us at support@enrollinsurance.com.

Please note that even if you opt out of marketing communications, Agility Insurance Services may still contact you by phone or email for transactional or informational purposes, including matters related to your account, enrollment, servicing, or other aspects of your business relationship with us.

Yes