Agency Control Center

Initial Info
Contact Info
Complete

Step 1: Initial Information

Recruiter (A Recruiter’s code is required for signup. If you do not have a Recruiter or do not know their code #, please contact support@agencyC2.com)

Recruiter Code:*

Password

Set a password that will be used to login to the Agent Backoffice.

At least eight characters
At least one upper and one lower case letter
At least one digit [0-9]
At least one symbol: ! @ # $ % * +
Examples: Password$1, SECURItY@2

Password:*

Confirm Password:*

Personal Information

First Name:*

Middle Name:

Last Name:*

Suffix:

Common Name:

Date of Birth:* / / i.e. 12/31/1970

Gender:* Male Female

SSN:*

Confirm SSN:*

Spouse Information

Marital Status:

Spouse Agent Code:

Spouse Name:

Insurance License

Do you currently have an active LIFE insurance license?* Yes No

* Required