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Demographic Data

First Name
Middle Name
Last Name
SSN  example: 123451234
Date Of Birth  example: 01/01/1971

Address Data

Address Line 1
Address Line 2
City
State
Zip Code
Phone Number  e.g. 5551115555
E-Mail Address

License Data

If you do not know your National Provider Number Lookup you can lookup on the nipr.com website. This link opens in a new window.

We report credits by license number. Please ensure that you have entered your license number correctly. Incorrectly entered license numbers lead to incorrectly reported credits.
National Producer Number
Broker License Number
Next License Renewal    
License State

Website Registration

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Specials/Offers By E-Mail
Course Updates By E-Mail
Password
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