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How did you hear about Kennedy Licensing?

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Resident License Status

What license(s) do you hold in your resident state? Corporation | LLC | LLP |
General Partnership | Limited Partnership | Sole Proprietorship |
Individual Only | None

What type? What Line:

Nonresident Licenses:

Where there is an option, do you prefer?
Do you need firm licenses in applicable states? yes no
If yes, how many individuals will be authorized under firm license(s)?
(NOTE: if you conduct your insurance business in a name other than your own, that entity must be licensed.  Keep in mind that when you have a firm license, this license does not automatically cover all representatives of your firm who are conducting business in a particular state, i.e., they must be licensed and named on the firm license.)

State licenses applying for:

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