HSA Business Partner Signup

What type of business partner are you?
What is your first name?
What is your last name?
What is your business name?
What is your street address 1?
What is your street address 2?
What is your city?
What is your state?
What is your zip code?
What is your preferred method of communication?
What is your email address?
What is your work phone number?	Ext
What is your mobile phone number?
What is your fax number?

What is your Tax Identification number?

Are you the only producer or will there be multiple producers?

How many producers will you be signing up with us?

What is the name of the agency?

My agency was not found:

What is the name of the agency?
What is the street address of the agency?
Street address 2
What is the city of the agency?
What is the state of the agency?
What is the zip code of the agency?
What is the phone number for the agency?	Ext
What is the tax identification number of the agency?

What is your average group size in your target market?

If you have a website, please provide the web address:

Are you licensed to sell financial securities?

What is the name of your broker/dealer?

Who are the most common carriers you typically use?

If you use a GA or MGA, who are they?

Other (if you use more than one):

Specify a logon user ID to be used for accessing the business partner portal
How did you hear about us?
Who?
Which one of our sales people did you speak to?
Is there anything you need immediate assistance with?

Agent: A benefit/insurance advisor that represents only a single carrier or company. (Captive)
Broker: A benefit/insurance advisor that contracts with multiple carriers or companies. (Independent)
Carrier Representative: An employee carrier field representative.
Consultant: Consultant - A benefit/insurance advisor that only works on a fee basis for their clients.
GA/MGA: A wholesaler of products/services for brokers/agents/agencies.

Tax ID - This is necessary due to federal tax reporting requirements.

Social Security Number (SSN): is a number issued to U.S. citizens, permanent residents, and temporary (working) residents. Its primary purpose is to track individuals for taxation purposes.
Employer Identification Number (EIN): is also known as a Federal Tax Identification Number, and is used to identify a business entity. Businesses are required to have an EIN.

The primary address you entered was:

USPS recommended address is:

Use the address entered. Use USPS recommendation. Make changes and revalidate.

The agency address you entered was:

USPS recommended address is:

Use the address entered. Use USPS recommendation. Make changes and revalidate.

The commission address you entered was:

USPS recommended address is:

Use the address entered. Use USPS recommendation. Make changes and revalidate.

You have chosen to sign up as a [BusinessPartnerType]. To properly configure this type of business partner, we request that you call our team of dedicated professionals to answer a few questions and set you up correctly. You can call us toll free at 888-677-1115; we are available Monday through Friday, from 8 a.m. – 4:30 p.m. Central Time. Thank you for your interest in doing business with UMB Bank.