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Agent Registration

Please take a few minutes to COMPLETE each section on the form below, and click to submit.

You only need to register once.

If you have any questions, comments or problems regarding the CPS web site, please click here to send us a note.

Thank you for using the CPS Insurance Services web site.

Registration Form

NOTE: Please make sure you use a valid email address and that it is spelled correctly.

First Name:
Last Name:
E-Mail Address: (See Note Above)
Re-Enter Your E-Mail Address:
Create a Password:
Re-enter the Password:
Company Name:
Street Address:
Suite or Unit #:
City:
State:
Zip code:
Phone #: xxx-xxx-xxxx
Fax #: xxx-xxx-xxxx
Your CPS Office:
Your Account Affiliation: (if applicable)
Do you market Annuities?YESNO
Do you market LTC?YESNO
Are your securities licensed?YESNO
If yes who is your broker dealer?:

As a CPS website user, you are included in the CPS email distribution list. Upcoming web conferences and meetings, a regular e-newsletter, carrier and product marketing, and other important news are included in the emails you will receive. Please proceed with the website registration process only if you understand this benefit will automatically be provided to you.