Disclaimer:

We take your privacy and data security seriously. The information collected on this page, including date of birth, Social Security Number, and banking information, is required to complete your onboarding process and verify your credentials. All data is transmitted and stored securely in compliance with industry-standard encryption and privacy regulations.

Please ensure that the information provided is accurate and complete. By submitting this form, you consent to the collection and secure storage of this information for the purpose of becoming an agent with Marketplace Insurance Exchange Group INC.

If you have questions or concerns about how your information is used or stored, please don't hesitate to contact us.