Add a Downline Agent

For questions about adding a downline agent, email agents@liferaft.co.

First name*

Last name*

Email*

Phone number*

State/Region*

NPN*

Downline Agent Level

Select the level contract at which you would like your downline agent appointed. There are two options available, a one-level hierarchy or a two-level hierarchy.

Resident License Number*

Referring Agent (Agency)*

Confirmation of E&O