1
Personal Information
Your legal name and contact details as they appear on your insurance license
Your information is encrypted and used only for carrier contracting purposes

Select all states where you currently hold an active insurance license

2
Background Disclosure
Standard insurance industry background questions — all agents must complete this section

Please answer each question truthfully. A "Yes" answer does not automatically disqualify you from contracting. Answering "No" to a question that should be "Yes" may result in immediate termination and legal action.

3
Beneficiary Information
Person to be notified and/or receive benefits in the event of your death or incapacitation
4
Required Documents for Contracting
To complete your carrier contracting, please upload the following documents
Used only for carrier contracting — not shared outside this process
Life & Health Insurance License(s)
Upload all active licenses
Errors & Omissions (E&O) Certificate
Must be current and active
Voided Check (Direct Deposit)
Used for carrier commission payments
W-9 Form
Required for tax reporting and payments
These documents are securely used to submit your contracting to insurance carriers on your behalf. Accepted formats: PDF, JPG, PNG.
What Happens After You Submit
Here's what to expect — read this carefully before signing
1
We Submit Your Contracting
We use your information and signed agreement to submit contracting requests to each carrier on your behalf.
2
Watch Your Email Carefully
Each insurance carrier will send you a contract or appointment request directly by email. Check your inbox and spam/junk folders regularly.
3
Complete Carrier Applications
You MUST complete each carrier's email request for your appointments to be approved. Missing these emails will delay or prevent your contracting.
4
Receive Your Carrier Login Credentials
Once approved, you will receive your user ID and login access for each carrier's agent portal.
5
Complete Certifications
Before selling, you must complete each carrier's certification and training requirements. These are required before you are authorized to sell.

Your contracting is NOT complete until you finish each carrier's email application and certification. EJ Insurance Group does not control carrier approval timelines or decisions.

5
Independent Agent Agreement
Read the full agreement below, then sign electronically
Not shared outside the contracting process · Legally binding under applicable e-signature law

Independent Agent Agreement

This Independent Agent Agreement ("Agreement") is entered into between ARVF, INC DBA EJ Insurance Group ("Company") and the undersigned independent agent ("Agent"). By signing below, Agent acknowledges and agrees to the following:

  1. Agent is contracted as an independent contractor, not an employee, of ARVF, INC DBA EJ Insurance Group. Agent is solely responsible for all taxes, insurance, and other obligations arising from their independent contractor status.
  2. Agent agrees to comply with all applicable state and federal regulations governing insurance sales and marketing, including but not limited to maintaining all required licenses and completing all required continuing education.
  3. Agent authorizes ARVF, INC DBA EJ Insurance Group to submit carrier contracting appointments on Agent's behalf to insurance carriers as mutually agreed. Agent acknowledges that carrier appointments are subject to each carrier's approval and underwriting guidelines.
  4. Agent agrees to maintain all required insurance licenses in good standing for the duration of this agreement and to immediately notify ARVF, INC DBA EJ Insurance Group of any license suspension, revocation, or disciplinary action in any state.
  5. Dispute Resolution: In the event of any dispute, claim, or controversy arising out of or relating to this Agreement, the parties agree to first attempt resolution through informal negotiation. If the dispute cannot be resolved informally within thirty (30) days, the parties agree to submit to mediation before pursuing any legal action. No party shall initiate a lawsuit or legal proceeding without first completing the mediation process in good faith.
  6. Agent acknowledges that commissions are subject to carrier payment schedules and company policies as outlined in the commission schedule provided separately. ARVF, INC DBA EJ Insurance Group makes no guarantee of minimum earnings or commission amounts.
  7. This Agreement may be terminated by either party with thirty (30) days written notice. In the event of material breach, ARVF, INC DBA EJ Insurance Group reserves the right to terminate immediately.
  8. Agent agrees not to engage in any conduct that would constitute fraud, misrepresentation, or unfair trade practice in the sale of insurance products.
Contracting Authorization

By signing this agreement, you authorize EJ Insurance Group to submit contracting applications to insurance carriers on your behalf using the information and documents provided. You understand that:

  • Each insurance carrier will send you a separate contracting or appointment request via email
  • You are responsible for reviewing and completing each carrier's application
  • Your appointment is not complete until the carrier approves your application
  • You must complete all required certifications before you are authorized to sell

EJ Insurance Group does not control carrier approval timelines or decisions.

Email Responsibility

You acknowledge that carrier communications will be sent to the email address you provided. It is your responsibility to monitor your email (including spam/junk folders) for carrier correspondence and respond promptly. Failure to respond to carrier emails may result in your contracting not being completed.

Your Book of Business

Your client relationships and book of business remain yours. EJ Insurance Group does not claim ownership of any client relationships you develop. Our role is to provide operational support, systems, and infrastructure to help you grow. This agreement does not create any non-compete or exclusivity obligation beyond what is required by individual carrier contracts.

By providing your electronic signature below, you acknowledge that you have read, understood, and agree to all terms of this Agreement. This electronic signature constitutes a legally binding signature under applicable law.

Electronic Signature
Type your full legal name exactly as it appears on your insurance license. This serves as your legally binding electronic signature.
Electronic Signature

Your submission is encrypted and stored securely. A confirmation email will be sent to the address you provided.
IP address, timestamp, and user agent are recorded for legal e-signature compliance.