Full Legal Name: NIPR Number: State of Resident License:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Phone Number: Email Address: Upline Name: Upline Email Address: Upline Phone Number: Is this agent currently with another IMO?YesNo [group imo-conditional] If yes, then who: [/group] Godspeed Comp Level:LVL 1LVL 2LVL 3LVL 4LVL 5LVL 6LVL 7LVL 8LVL 9LVL 10 Message