Join NFGB – NexVision

Technology Package

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First Name *

Last Name *

Email Address *

Username (lowercase alphanumeric) *

Recruiter Name

Select your Recruiter *

Additional Info

City *

State *

Phone *

Date of Birth *

Social Security Number *
Why do we need your SSN?
1. Contract with NFG carriers.
2. Accurate Payroll and Tax forms.
3. Have a unique identifier to avoid errors if you have a similar name as another agent

Primary Beneficiary *

Primary Beneficiary Social Security Number *

Contingent Beneficiary

Contingent Beneficiary Date of Birth

Contingent Beneficiary Social Security Number

By Checking this box I confirm I agree to the NFGB Independent Agent Agreement. Click here to view and save the agreement.

Technology Package
There is a technology package fee of $100 one time charge.
This is the only requirement to join NFGB.
I understand that NFGB charges a one time technology fee of $100 and it is non-refundable.

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