LRC and Associates
Initial Medicare Supplement Kit Request
with Medicare Powerpoint Presentation


Agent's Licensing Paperwork

Use our new easy online license appointment system.  We'll have you appointed and ready to start making money in the senior market in just a couple short days.

We need to get you appointed BEFORE you can write business so get the licensing done ASAP.

Complete the the form below and we will send your licensing link, requested materials and a link to the Appointed-Agents Only access page.

We will also need a copy of your NYS license, DOB and Social.  You can fax (845-425-9312), email it to ( or upload it to our secure drop-box with a current copy of your NYS insurance license.


Contact me with any questions, 1-800-443-5149 X1002 or

* Required fields
Name *
E-mail Address *
Last Name *
First Name *
Are you appointed with First United American? *
If so, with what agency?
What State(s) do you wish to receive information for
Address to send your kit(s) *
Primary Phone Number
Secondary Phone Number
Fax Number

Please enter the code shown above and click the 'Submit Form' button. This additional step is required to help protect against message spam.