Join Empower Brokerage

Before joining Empower Brokerage, it is important that we know a little about you.
Please complete the information below to proceed:


    Empower Brokerage Recruiter (if known)

    First Name *

    Last Name *

    Best Contact Phone *

    Email *

    City *

    State *

    NPN (National Producer Number) *

    Residence State License # *

    What is your product focus?
    Individual HealthMedicare AdvantageMedicare SupplementsLife & FinancialSupplementalGroup

    Do you use a smart phone or tablet?

    Are you currently working under another FMO or Agency?

    Please tell us about your other Agency or FMO affiliations.

    How do you want to be paid commissions?
    As EarnedAdvances

    To receive advances, you must complete the following within 5 business days of requesting your first carrier:

    1. Complete the Advances Form and return it to Fax (817) 410-5999. download here

    2. Compete the online Agent Orientation class inside Empower University. (once you have a login)

    *If you do not complete these within 5 business days of requesting your first carrier, you will automatically be set to "As Earned" and your contracting will proceed.

    Any comments? Just let us know.

    Thank you! The answers to these questions will better help us determine the fastest way to get you up and running with Empower Brokerage.


    By checking this box, you consent to receive text messages from Empower Brokerage and/or a licensed Empower Brokerage agent. These messages may include marketing messages (e.g., promotions, reminders) and follow-up communications related to your inquiry to the number provided, which may include the use of an autodialer. Message and data rates may apply. Message frequency varies. You can unsubscribe at any time by replying STOP or clicking the unsubscribe link.

    By clicking and submitting this form with my name, phone number, and e-mail address, I agree that I am at least 18 years of age. By clicking and submitting this form, I understand that I am enrolling in an ongoing marketing campaign about insurance services and other options from Empower Brokerage or a licensed agent, and I will receive phone calls and e-mails (even if that phone number is on any Do Not Call Registry or is a mobile number). If you want to opt out of receiving future e-mails from Empower Brokerage, you can do so at any time by clicking the “unsubscribe” button in our e-mail. For more details, see our Privacy Policy.