Online Licensing Instructions

Please complete the form below via the “Click Here” link. You can save and then email us the form or print and then email or fax us the form. Please make sure to follow these instructions,

  1. Complete all sections of the form
  2. Include a copy of your insurance license
  3. Include a copy of your E&O declarations page
  4. Include a voided check for automatic deposit of your commissions
  5. For long term care, include an update-to-date copy of your Partnership Certification
  6. For annuities, include a copy of your 4 hour annuity CE
  7. Make sure your AML training is up to date

Once we receive your forms we will process and fax you the completed carrier appointment forms for your signature. Thank you for choosing Diversified Brokerage Specialists!

We make selling insurance fast and easy!

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Diversified Brokerage Specialists, Inc.

I truly enjoy working with your staff, especially Florence Reagan.  My business is predominant property and casualty but since I have found Diversified Brokerage my life sales have soared.  It's like having a life division for my agency but hosted by Diversified Brokerage.  It is a win win for both.  Diversified is on it from the day you send the application to the day you receive the policy in the mail.  Thank you for all that you do!
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