Broker Onboarding | Our 365 Financial Solution

Agent / Broker Application

Complete all fields below. This information will be used for your agency file and carrier contracting.

First Name *

Last Name *

Email Address *

Phone Number *

Mailing Address *

Date of Birth *

Social Security Number * Encrypted & stored securely. Required for carrier contracting.

Florida License Number *

License Type *

License Expiration Date *

NPN (National Producer Number) *

Years of Insurance Experience

Lines of Authority (check all that apply)

Life Health Annuities Medicare

Referring Broker (if any)

Current E&O Carrier

Have you ever had an insurance license revoked, suspended, or been subject to regulatory action?

Please explain

Document Uploads

Upload the following required documents. Accepted formats: PDF, JPG, PNG (max 10MB each).

Government-Issued Photo ID *

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Drop your photo ID here or click to browse

Driver's license, passport, or state ID

Florida Insurance License *

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Drop your license copy here or click to browse

Active Florida license (2-15 or applicable lines)

E&O Insurance Certificate *

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Drop your E&O certificate here or click to browse

Must list Our 365 Financial Solution LLC as additional insured

W-9 Tax Form *

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Drop your W-9 here or click to browse

Completed and signed IRS Form W-9

Direct Deposit Authorization

Provide your banking information for commission payments. This information is encrypted and stored securely.

Account Holder Name *

Bank Name *

Account Type *

Routing Number *

Account Number *

Confirm Account Number *

🔒 Security Notice: By providing your banking information, you authorize Our 365 Financial Solution LLC to deposit commission payments into the account specified above. This authorization remains in effect until you provide written notice of cancellation.

Handbook Acknowledgment & E-Signature

Review the acknowledgment below, then provide your electronic signature.

Acknowledgment & Agreement

By signing below, I acknowledge that I have received, read, and understand the Our 365 Financial Solution LLC Broker & Agent Handbook (Version 1.0). I agree to comply with all policies, procedures, and standards outlined in this handbook.

I understand that:

This handbook is a guide and does not constitute a contract of employment or guarantee of continued affiliation.
The agency reserves the right to modify, amend, or update this handbook at any time.
My relationship with Our 365 Financial Solution LLC is that of an independent contractor, not an employee.
Violation of these policies may result in corrective action, up to and including termination of my Independent Contractor Agreement.
I am responsible for maintaining my insurance license(s), E&O coverage, and compliance with all applicable laws and regulations.

Independent Contractor Acknowledgment

I understand that as an independent contractor, I am responsible for my own taxes, insurance, and business expenses. I am not entitled to employee benefits, workers' compensation, or unemployment insurance from Our 365 Financial Solution LLC.

Confidentiality Agreement

I agree to keep confidential all proprietary information, client data, business strategies, and internal processes of Our 365 Financial Solution LLC, both during and after my affiliation with the agency.

I have read and agree to the terms of the Broker & Agent Handbook, including all policies on compliance, conduct, and compensation. *

I acknowledge that I am entering into an Independent Contractor relationship with Our 365 Financial Solution LLC. *

I agree to the Confidentiality Agreement and will protect all proprietary and client information. *

Your Signature *

Sign above

Full Legal Name (Typed) *

Date

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Onboarding Complete!

Thank you for submitting your onboarding information. Your application has been received and is being reviewed by the Agency Principal.

Your Agent Number

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Confirmation Number

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Submitted By

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Date & Time

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Next Steps

Emmanuelle Cador will review your application and initiate carrier contracting within 3–5 business days. You will receive an email confirmation with your login credentials for the Lead Capture System and Agent365Pro.