Ready to Get Started?

If you’re ready to begin your onboarding with Lumen Insurance Group, please complete the form below with your information and required documents.
Our contracting team will review your submission and reach out to guide you through the final steps for a smooth and efficient onboarding experience.

Welcome to Lumen Insurance Group!

Please make sure to provide all the required information.

If you have any questions, please contact us at [email protected].

Contact Type *

First Name *

Last Name *

Date of birth *

Phone *

Email *

Address

Street Address *

City *

State *

Postal code *

Direct Agency *

NPN *

Social Security Number *

Resident State License Number *

Resident State License *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Driver License *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

FFM and/or State Based Certificate (if applicable) *

PDF ( max 25 Files )

E&O

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Release Letter

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

Other Licenses

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 25 Files )

I agree to the terms & conditions provided by the company. By providing my phone number and email, I agree to receive text messages and marketing emails from the business.

Address:

520 Post Oak Blvd, Suite 800. Houston, TX 77027.

Contact

(346) 680-4252

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