MeridianLight Agent Onboarding

Congratulations and welcome to MeridianLight — your journey starts here.

This onboarding collects the information required to activate your agent account and commission payments.

Estimated time: 3–5 minutes

Basic Information

First Name *

Last Name *

Phone *

Email *

Date Of Birth *

Address

Street Address

City

State

Country

Postal Code

I consent to receive marketing text messages from MeridianLight LLC about training opportunities and business updates at the phone number provided. Message frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

I consent to receive non-marketing text messages from MeridianLight LLC about job status and onboarding Updates. Message frequency may vary, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Licensing Information

Please provide your insurance licensing information. This information is required for carrier contracting and compliance verification.

Legal Name *

License Status *

NPN

Resident State *

License Number

Additional Licensed States

Upload Home State License

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

W-9 Tax Form

Contractor Tax Form (W-9 Equivalent)

Please complete this tax form before receiving any commissions, bonuses, or residual payments from MeridianLight.

This information is required for IRS Form 1099-NEC reporting.

Legal Name on Tax Return *

Business Name / Disregarded Entity

Taxpayer Identification Number (SSN/EIN) *

Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because:
(a) I am exempt from backup withholding, or
(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or
(c) the IRS has notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person.
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Leave unchecked if not applicable

I am subject to back up withholding.

Certification Agreement *

I certify that the information provided on this form is true and correct. By signing electronically, you agree that your electronic signature is the legal equivalent of your manual signature and that this form may be stored electronically by MeridianLight for tax reporting and compliance purposes.

Signature *

Clear

Printed Name *

Date Signed *

ACH Payment Authorization

Please provide your banking details so MeridianLight can deposit commission, bonus, and incentive payments via ACH.

Your information is encrypted and used only for payment processing and accounting compliance.

Legal Full Name (as it appears on bank account) *

Bank Name *

Routing Number *

Account Number *

Account Type *

I authorize MeridianLight LLC to deposit commissions, bonuses, overrides, and other incentive payments into the bank account listed above via Automated Clearing House (ACH).

I certify that I am an authorized signer or owner of this bank account and that the information provided is accurate.

I understand this authorization will remain in effect until I provide written notice to MeridianLight to modify or revoke it, and I agree to allow MeridianLight reasonable time to act on any such notice.

I acknowledge that erroneous deposits or overpayments may be corrected in accordance with applicable banking regulations.

I agree to the ACH authorization terms above

By signing electronically, you agree that your electronic signature is the legal equivalent of your manual signature and that this authorization may be stored electronically for payment processing, accounting, and audit purposes.

Agent Electronic Signature *

Clear

MeridianLight Agent Agreement Acknowledgment

View Full MeridianLight Independent Contractor Agent Agreement

By signing below, I acknowledge that I have received and reviewed the MeridianLight Independent Contractor Agent Agreement and related policies, including the MeridianLight Compensation Plan, Chargeback & Commission Reserve Policy, Supervision Manual, and Compliance Procedures.
I understand that I operate as an independent contractor and that all insurance business written through MeridianLight is subject to carrier rules, MeridianLight policies, and applicable state regulations.
I agree to maintain required licensing, maintain Errors & Omissions insurance, comply with MeridianLight sales and compliance procedures, and accept responsibility for chargebacks, debit balances, and commission adjustments as described in the MeridianLight policies.
I acknowledge that MeridianLight retains control of carrier contracts under the LOA structure and that commissions are payable only after receipt from the carrier.
I agree to comply with MeridianLight supervision, CRM documentation, advertising guidelines, and regulatory requirements.
I understand that this electronic signature constitutes my legally binding acceptance of the MeridianLight Agent Agreement.

Agreement Confirmation *

I have read and agree to the MeridianLight Agent Agreement and policies.

Agent Signature

Clear

Date Signed *