Home Page  Agents Page  Customers Page  Contact Us

Agent Registration  

Important:  You must have your APFC Agent Number to register
If you are not an Insurance Agent or Broker, DO NOT complete this form
Only one registration per Agency

All information will be kept confidential.    * = Required Field

  Agency Name*  
APFC Agent Number*  
Agency Contact Name*
One Name per Agency
  City, State & Zip*           
  Phone*                          Fax  
  Agency Email*    
One Master Email per Agency
Used for email to Agency & Password retrieval. 
All Customer Reports and communications will be sent to this email address only.

  Agency Password*   6 to 10 Letters or Digits only, Case Sensitive
One Password for all Agency Staff to Logon with
  Retype Password*  

Agency Checking Account Information
Only needed to submit payments collected from your customers
Not needed for web access to Customers Accounts  

  Bank Name  
  Bank Routing Number  
  Checking Acct Number  
  Name on Checking Acct  
  Address on Checking Acct  
  City, State & Zip on Acct         

Be sure to check the "
I'm not a robot" box below before pressing submit


Please press button only once.
You will be directed to a page confirming receipt of your registration.