CPS Insurance

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Site Registration

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

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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 Life?YESNO
Do you market Annuities?YESNO
Do you market DI?YESNO
Do you market LTC?YESNO
Are your securities licensed?YESNO
If yes who is your broker dealer?:

18551 Von Karman Ave., Suite 150, Irvine, Ca 92612 Phone 949.863.0700

CPS Insurance is currently licensed in the State of California under California Corporate License #0571612

The CPS Insurance Services web site is maintained exclusively for active producers contracted with carriers through CPS, and is intended for agent use only. All information is intended for use as a guide, or as reference, and is believed to be current as of the date of its posting. Any misrepresentation of the information contained in the CPS Insurance Services web site by its users is strictly prohibited.

The list of registered CPS web site users is reviewed for business-related activity on a regular basis. Only registered users will receive site support of any kind. Comments and suggestions are encouraged.