Apply to Partner — BrokerEvolve

Contact

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Identity

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License

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Contracting

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Attribution

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Fit

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Agreement

Apply to Partner
with BrokerEvolve

Application takes approximately 60–90 seconds to complete.

Contact Information

Your primary contact details for platform access and onboarding.

Full Legal Name (as it appears on your insurance license) *

Please enter your full legal name.

Email Address *

This will be used for your BrokerEvolve login.

Please enter a valid email address.

Phone Number *

Please enter your phone number.

Broker Identity

Core identity fields used for contracting, hierarchy, and AOR protection.

NPN (National Producer Number) *

Please enter your NPN.

Agent Type *

Please select your agent type.

Agency or Independent? *

Please select your structure.

Licensing Profile

Used for license verification and state-specific visibility settings.

Resident License Number *

Please enter your resident license number.

Years Licensed *

Please select your years licensed.

States Licensed In *

Please select at least one state.

Upload License Report (Optional)

📄

Click to upload or drag and drop your license report (PDF)

Optional. Connects to license tracking and Sircon verification.

Contracting & Market Focus

Determines which contracting workflows and modules activate for your account.

Which contracts are you seeking access to through BrokerEvolve? *

Please select your contracting preference.

Currently appointed with any carriers? *

Please select an option.

Do you currently use HealthSherpa? *

Please select an option.

Recruiting Attribution

Helps us route your application and assign hierarchy correctly.

Referral Source *

Please select your referral source.

Referring Agent NPN or Email *

Please enter the referring agent's NPN or email.

Platform Fit (optional)

Helps us personalize your onboarding experience.

What are you primarily looking for from BrokerEvolve?

CRM + Client Management Training & Structure Quote & Enrollment Access Scaling Infrastructure

Tell us about your current situation and goals

Agreement

Please review and confirm before submitting.

I confirm that the information provided is accurate and I agree to be contacted by BrokerEvolve regarding platform access and contracting. See our Terms & Conditions and Privacy Policy.

You must confirm to continue.

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Founding Member Access Approved agents will receive Founding Member access with locked lifetime pricing and priority onboarding.

Reviewed within 24–48 hours Limited spots available No obligation

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Application Submitted

Your application has been received. A member of the BrokerEvolve team will review your information and reach out within 24–48 hours.

Explore the platform at brokerevolve.com.

Apply to Partnerwith BrokerEvolve

Application Submitted

Apply to Partner
with BrokerEvolve