Contract with Upstream Life as an independent insurance agent. Become an Agent Name First Last PhoneEmail What is your city and state of residence? Are you currently licensed as an insurance agent?*Select oneYesNoIf yes, select the states in which you are licensed:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDo you have a securities license?Select oneYesNoIf yes, what are your current assets under management? MessageCommentsThis field is for validation purposes and should be left unchanged.