Appointment Forms & Process

Appointment Forms & Process

Athene

Please Fill out the following Appointment Application.  In addition, we will need:

  • E&O Certificate.
  • AML- Exact date and with whom you completed it with.
  • Letter(s) of Explanation and Pertinent Documentation for any yes answer(s) on application. All Letter(s) of Explanation must be typed with a handwritten signature.

Banner Life

Please Fill out the following Appointment Application.  In addition, we will need:

  • E&O Certificate.
  • AML- Exact date and with whom you completed it with.
  • Letter(s) of Explanation and Pertinent Documentation for any yes answer(s) on application. All Letter(s) of Explanation must be typed with a handwritten signature.

CLICK HERE FOR APPOINTMENT APPLICATION

LSW

Please have Your Office Contracting Coordinator Request an Invitation for Appointment with LSW.   In Addition, Submit the Following Items at the Time of Request:

  • E&O Certificate.
  • AML- Exact date and with whom you completed it with.

If any yes answer(s) are given when Completing the Appointment Application, Please Include:

  • Letter(s) of Explanation and Pertinent Documentation for any yes answer(s) on application. All Letter(s) of Explanation must be typed with a handwritten signature.

If not yet a VP please send above items to your VP for review and then they will enter it into the credentials-submit contracting area or if you have obtained the position of VP or higher please submit directly to The Company by clicking here

North American Company

Please Contact Your Office Contracting Coordinator for an Appointment Application.

*The Company does not sign provider termination forms.