Licensing For Producers Licensing It’s easy to get started with Connexion. Licensing@ConnexionInsurance.com Phone: 800-228-5798 | Fax:425-918-5539 Name* First Last Email* Phone*Address* Street Address Suite / Apt. # City State / Province / Region ZIP / Postal Code I am:*a producer working on my ownwith an agency with other producers working for meAgency Name*Number of Producers w/Agency*Years in Business*Which of the following states do you wish to be affiliated in with Connexion?* WA OR ID AK Please indicate your business' current areas of focus/scope of work by providing your estimated percentage for each line of business below (totaling 100%). Individual Medical Percent of Business*Number of Clients*Medicare Percent of Business*Number of Clients*Small Group Medical Percent of Business*Number of Clients*Ancillary Lines (Dental, Life, etc.) Percent of Business*Number of Clients*Financial Services/Other Percent of Business*Number of Clients*Current Carrier Relationships* Premera Blue Cross Aetna Assurant Cigna Lincoln Regence Blue Shield Multicare Reliance GroupHealth Unum United HealthCare Standard Other Other Carrier NameWhy Connexion?*Please provide a brief summary of why you are interested in working with Connexion.By clicking submit, you agree to our terms & conditions.PhoneThis field is for validation purposes and should be left unchanged.