Broker Registration

Enter your contact information below to submit your broker registration to PreferredOne.

First Name:

Last Name:

Phone Number:



Email Address:

Broker Type:

Please provide the following information, this will help us serve you better when we contact you:

Name of your affiliated Agency:
How long have you been selling in the market you are inquiring about?

List the companies you are currently appointed with:

What products do you currently Market?
How many individual non-medicare applications do you personally sell and service on an annual basis?
Why are you interested in selling for PreferredOne?
Have you had a bankruptcy within the last five years?
If yes, provide the date and details.

Need Assistance?

The PreferredOne Customer Service Call Center is available between 7:00 a.m. and 7:00 p.m. CST, Monday through Friday.

Twin Cities Area:
Outside the Metro Area:
For Hearing Impaired:
763.847.4013 (TTY)

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