Sun Health & Dental — Producer Enrollment

Personal

Agreement

Review

Producer information

First name *

Last name *

Email address *

Mobile phone * 10-digit US phone number

Home phone

Street address *

City *

State

Zip code *

Office phone

License & agency

I'm not a licensed insurance agent

License type *

License number *

NPN * Required for the Producer Agreement

Are you enrolled with an Agency? *

Agency name *

Security check

Producer Agreement (SHDP-2026-10) — read carefully

Fields below are filled from your application. Sign both the Agreement and the Commission Schedule Addendum.

Signature date —

Effective date —

Loading full Producer Agreement…

I confirm that the information I provided is correct, and I have read and agree to the Producer Agreement and Commission Schedule Addendum.

Producer Agreement signature (page 4) *

Sign the Producer Agreement

Commission Schedule Addendum signature (page 5) *

Sign the Commission Schedule Addendum

Review your application

Verify all details before submitting.

After submitting, Sun Health & Dental will receive your signed agreement for countersignature. You will get a confirmation email now, and the fully executed PDF by email once both parties have signed.

Application submitted!

Your application and signed Producer Agreement were received. Sun Health & Dental will countersign next. Check your email for confirmation; the final PDF will be emailed once both parties have signed.