FFL Allegiance New Hire Form

Put Agent In Licensing Class

Agency Name *

Salutation *

First Name *

Middle Name or Initial *

Last Name *

Date of Birth *

Phone *

Email *

Address *

City *

State Dropdown *

Postal Code *

Comp % Rate *

Direct Upline Name *

Direct Upline Email *

Direct Upline Phone *

Recruiter Name *

Lead Source *

Notes: