Thank You for Your Interest in our IntegritySTC Initiative!

What Are The Next Steps?

Complete the form below to request appointments with the carriers and products of your choice.

First Name

Last Name

Email Address of individual submitting request

Phone Number

Agency Name

Carrier Appointment(s) Being Requested: (For the greatest success, we recommend contracting with all) Carrier Appointment(s) Being Requested: (For the greatest success, we recommend contracting with all) Guarantee Trust Life (GTL) Recover Cash STC Guarantee Trust Life (GTL) Short-Term Home Health Care ManhattanLife OmniFlex STC ManhattanLife Home Health Care Select True Freedom Home Care Service Plans Wellabe Essential Care STC

Agency's Licensing Contact (Full Name)

Agency's Licensing Email

Message

5 + 5 =

PLEASE NOTE: Form submissions are directed to the appropriate Integrity Business Unit handling contracting for requested carrier(s). All requests are handled as a priority, however, there may be a delay (between a few hours to a couple business days) before your agency’s Licensing person is contacted.