Independent Producer Commission Schedule - Securian Dental
Independent Producer Commission Schedule - Securian Dental
Independent Producer Commission Schedule - Securian Dental
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<strong>Commission</strong> Reports User Request Form<br />
<strong>Securian</strong> Life Insurance Company<br />
Requirements for Online <strong>Commission</strong> Report Access:<br />
Must be paid commissions directly<br />
(if you are a broker that assigns commissions to your agency, only your agency may request a UserID)<br />
Must have an assigned Vendor ID<br />
(this will appear on your first commission payment)<br />
You will receive confirmation by email when your secure access setup is complete.<br />
Payee Information:<br />
Vendor ID #<br />
Type of Payee: Broker Agency<br />
Agency Name:<br />
Agency federal Tax<br />
Identification Number:<br />
Main Contact<br />
Name:<br />
Main Contact<br />
Title:<br />
Main Contact<br />
Email:<br />
Main Contact Phone:<br />
Signature<br />
Date<br />
For <strong>Securian</strong> <strong>Dental</strong> Plans <strong>Commission</strong> Department Use:<br />
Date Received: Agent ID: Date/Initial: Assigned UserID: Assigned Password:<br />
SEND COMPLETED DOCUMENT TO: Email: <strong>Securian</strong>_<strong>Commission</strong>@<strong>Securian</strong><strong>Dental</strong>.com<br />
Fax: 1.877.631.8953<br />
More Information: www.<strong>Securian</strong><strong>Dental</strong>.com<br />
Phone 1.866.201.1818 Option 1<br />
Postal:<br />
<strong>Securian</strong> Agent Appointments<br />
730 South Broadway<br />
Gilbert, MN 55741<br />
Form: - SDUserRequest<br />
REV 7-2011
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