Agent Onboarding Packet | Crown Merchant Financial

Complete this form to generate your Crown Merchant Financial agent onboarding packet. Everything you enter goes directly into the official fillable PDF — no printing or scanning needed. It takes about 15–20 minutes. Have handy: your insurance license info, NPN, driver's license, a voided check, and your E&O certificate.

Your Information

First Name *

M.I. (optional)

Last Name *

Social Security # *

Gender *

Date of Birth *

Email *

Marital Status (optional)

Phone *

Cell (if different)

Fax (optional)

Title (e.g. Agent)

Maiden Name (if applicable)

Licensing

Resident Insurance License # & State *

NPN (National Producer Number) *

Driver's License # *

DL State *

Residential Address (no PO boxes — city/state not needed)

Address Line 1 *

Line 2

Zip Code *

Living Here Since *

Mailing Address

Same as residential

Address Line 1

Line 2

Zip Code

Since

Doing Business As

Leave this as pre-selected unless we've discussed otherwise.

Solicitor / LOA (standard) Individual Business Entity

Assigning commissions to *

EIN *

Business Name *

Website

Your Title in the Business

Business Phone

Business Fax

Principal Name

Principal Title

Principal Email

Company Type

Corporation Partnership LLC LLP

Corporate Address Line 1

Line 2

Zip Code

At This Address Since

Employment History

Please provide the past 7 years of employment history, most recent first.

Address History

Past 7 years of address history. Your current residential address counts as the first entry — we pre-fill it for you. City/state not needed.

Commission Beneficiary

Who should receive any commissions owed to you if something happens to you? Recommended, but optional.

Beneficiary Name

Beneficiary SSN

Relationship

Street Address

City

State

Zip

Practice Details

May a carrier publish your name in company publications?

Yes No

If no — is recognition (awards, conference) acceptable?

Yes No

Is new business being submitted?

Yes No

Deliver client contracts to agent? (client otherwise)

Yes No

Commission Frequency

MDRT Status (if any)

Broker/Dealer TIN (if applicable)

Have you ever been expelled or disciplined by a professional organization such as NALU?

Yes No

If you currently are, or ever have been, FINRA registered — do you have any reportable events on your U-4 or U-5?

Yes No

Are you now, or have you ever been, a party to a legal settlement of a dispute involving a client or company for which you worked?

Yes No

Background Questions

Carriers require every question answered. If any answer is Yes, you'll add a letter of explanation on the next screen.

Letter of Explanation

You answered Yes to at least one background question. Provide a full, detailed explanation including specific dates. Add up to three separate incidents.

Licenses & Certifications

AML (Anti-Money Laundering) Provider *

AML Course Completion Date

Provider / Certificate Details (you'll also attach the certificate later)

Are you a Registered Rep with FINRA?

Yes No

Broker/Dealer Name

CRD #

Honors you currently hold (optional)

Direct Deposit (EFT)

Direct deposit details for your commission payouts. You'll attach a voided check or bank letter in the Documents step.

Account Owner Name *

Routing / ABA # *

Account # *

Financial Institution Name *

Account Type *

Checking Saving

Advance Commissions

Are you requesting advance commissions? If yes, the Agent/Agency Debit Balance Agreement (personal guarantee for chargebacks) will be signed as part of this packet.

Yes No

Authorizations

These correspond to the authorization forms inside the packet. Your signature and initials (captured at the final step) are applied to each form you authorize here.

Signature Authorization

Authorizes our contracting office to affix your signature to carrier contracting forms submitted through SureLC. Required to process appointments.

VectorOne Debit-Check Authorization

Authorizes a commission-related debit balance screening. Your initials are applied to statements A–E and your signature to the form.

Email Setup & Signature Approval

Send carrier appointment requests to my own email address for review and signature Create a dedicated contracting email address for me to review appointment requests

Carrier Appointments

For each carrier you want to be appointed with, enter the state(s) — e.g. IL, MO, TX. Leave blank to skip a carrier. Not sure yet? Leave them all blank and sort it out with your upline later.

ACA

Medicare Advantage / MAPD / PDP

Health & Life

Supporting Documents

These get attached to the end of your packet automatically. Photos are fine — make sure text is readable. Accepted: JPG, PNG, or PDF.

Photo ID — Driver's License, State ID, or Passport *Government-issued photo ID; required by some carriers

Voided Check or Bank Letter *Must show name on account, routing #, account #

E&O Certificate of Coverage *Must list your full name as the insured

AML CertificationCompleted within the last 24 months (skip if LIMRA — name/date given earlier)

Carrier Release DocumentsOnly if you're active with a carrier you're requesting appointment to

If a required document isn't handy, you can still submit — but your contracting can't start until your upline has everything.

I'll send missing documents separately

Sign & Submit

Your Signature *

Draw with your finger or mouse. Applied to the attestation, EFT, Signature Authorization, VectorOne, and Email Setup forms.

Sign above the line

Your Initials *

Applied to the VectorOne statements (A–E) and your email setup choice.

Initials above

By signing and submitting, you attest that the information provided is true and accurate to the best of your knowledge, you acknowledge that if any information changes you will notify your agency office within 5 days, and you authorize our contracting office to register you with its contracting platforms. You also agree to the Signature Authorization, VectorOne Debit-Check Authorization, and Email Setup terms contained in the packet.

I have read and agree to the statements above *

A copy of the finished PDF downloads to your device, and it's sent to Crown Merchant Financial automatically.

🎉

Packet Submitted

Your completed onboarding packet was sent to Crown Merchant Financial and a copy was downloaded to your device. We'll review it and kick off contracting — expect to hear from us within 1–2 business days.

Questions? Email nquaranta@crownmerchantfinancial.com