In just 3 easy steps you can become authorized to have Express Estate Plans^SM provided to your clients:

• Complete and return to us your Authorized Facilitator Information below for review and approval.
• When your  Request is approved, an Authorized Facilitator Agreement will be sent to you for execution.
• Return the executed Authorized Facilitator Agreement along with your $100 authorization fee.

Upon acceptance, you will be sent your New Facilitator Welcome Kit, including your username and password required to access the web site.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Address *

City *

State *

you of hold,

Zip Code *

Phone *

Email *

Fax

Licenses you hold, and Sate *

Name of Broker Dealer *

Tax ID # (for 1099 Form)

Submit