Please use the following information for help using the Agent Application for Service.

Basic Information

The application and associated forms are submitted electronically and will apply electronic signatures ("E-Signatures") to all forms as required.


To successfully submit your electronic application, you must follow these steps completely:

  • STEP 1 - Click the "Sign Up" link at the top and enter your information.
  • STEP 2 - Read and electronically sign the documents.
  • STEP 3 - Read final instructions and print the complete package and Document Transmittal Form generated from the application process. Click the "Submit Application" button to complete the signup process.
  • STEP 4 - Fax the Document Transmittal Form along with your insurance license and any other required documentation.

Note: All fields below in red must be entered in order to successfully submit your application.


Each section below contains a brief summary of the information in the setup process. For more information, you may click on each section to expand additional information.

Delivery System Requirements

Both the application for service and the Insurance Link system are browser-based applications that may require additional system settings to work properly. If you are having issues, please click here to ensure that all requirements are met.

  • Browsers:
    • Internet Explorer versions 7.0 and higher.
      • Internet Explorer 6.0 is supported, but may not perform as well as newer versions.
    • Mozilla Firefox versions 3.0 and higher.
    Note: The browser cipher strength must be set at 128 bit encryption for secure connections.
  • Browser Settings:
    • Cookies must be enabled.
    • JavaScript must be enabled.
    • Pop-Ups must be enabled, or an exception must be made for the "*.lexisnexis.com" domain.
    • Temporary Internet Files set to "Every Visit to the Page" (IE only).
Agency Contact Person

This person will be the main point of contact for the agency applying for access to the Insurance Link system. The person completing this package MUST be authorized to sign legal documents for the agency.

  • First Name: Enter the first name of the person who will be using this account.
  • Last Name: Enter the last name of the person who will be using this account.
  • Business Title: Enter the business title of the person who will be using this account. A legitimate "business" title is required (i.e., Manager, Owner, President, Principal, Agent, etc.). Mr., Mrs., Ms., agency name, or person's name are NOT acceptable business titles.
  • E-mail Address: Enter the e-mail address of the person who will be using this account. It will be used to provide technical support and error reports to your agency. It will not be used for marketing or sales purposes and will not be sold to other businesses. Be assured that it will be held in the strictest confidence.
  • Date of Birth: Enter your date of birth.
Additional Contacts

Use this feature to add any additional contacts of people who may need to order reports from LexisNexis. If you are unsure about any additional contacts at the time of filling out your application, you can wait and manually submit User ID applications at a later date using the User ID form you are given from completing the setup process.

After submission of your application, an e-mail will be sent to each additional individual you specify. The e-mail will contain instructions on completing the User ID application for that individual.

  • First Name: Enter the first name of the person who you are requesting access.
  • Last Name: Enter the last name of the person who you are requesting access.
  • E-mail Address: Enter the e-mail address of the person who you are requesting access. It will be used to send an e-mail with further instructions on completing the User ID setup process. It will not be used for marketing or sales purposes and will not be sold to other businesses. Be assured that it will be held in the strictest confidence.
  • User Phone: Enter the phone number of the person who you are requesting access.
  • User Fax: Enter the fax number of the person who you are requesting access.
  • Mother's Maiden Name: Enter the mother's maiden name of the person who you are requesting access. This is required for security purposes.
Agency Information

The information in this section references the agency that will be ordering reports from the Insurance Link system. This agency must have all proper and required supporting documentation in order to successfully create an account.

  • Agency Name: Enter the name of your insurance agency.
  • DBA/AKA (Does Business As/Also Known As): If your agency is referred to by a name different from the name entered in the Agency Name field above, enter that name here.
  • Business Phone: Enter the business telephone number of your insurance agency.
    • Is this a cell phone? If a cell phone is your ONLY telephone, you must submit any TWO (2) of the following documents along with your valid insurance license:
      • Copy of a phone bill
      • A carrier contract (for insurance agents)
      • Copy of a cable bill
      • Copy of an Internet Service Provider bill
      • Copy of a credit card statement
      • Copy of a utility bill
      These two additional documents MUST show the same name and address as is on this application.
  • Business Fax: Enter the business fax number of your insurance agency.
    • Is this a dedicated fax line? If this is not a dedicated fax line, you must submit any TWO (2) of the following documents along with your valid insurance license:
      • Copy of a phone bill
      • A carrier contract (for insurance agents)
      • Copy of a cable bill
      • Copy of an Internet Service Provider bill
      • Copy of a credit card statement
      • Copy of a utility bill
      These two additional documents MUST show the same name and address as is on this application.
  • Street Address: Enter the street address of your insurance agency. P.O. Box not accepted.
  • City: Enter the city of your insurance agency.
  • County: Enter the county where your insurance agency is located.
  • State: Enter the 2-character state code where your insurance agency is located. You may use the down arrow to the right of the field to see a list of valid state codes.
  • Zip: Enter the zip code where your insurance agency is located. Enter the zip + 4, if you know it.
  • Federal Tax ID No. OR Social Security No.: Enter either your business Federal Tax ID number of your insurance agency or enter your Social Security Number.
Witness Information

A witness to your signature is REQUIRED for the State of Maryland "Privacy Protection Policy" form which is a part of this package. A person [other than yourself] is required to witness your signature/completion of this application.

  • First Name: Enter the first name of the witness.
  • Last Name: Enter the last name of the witness.
  • Business Title: Enter the business title of the witness. A legitimate "business" title is required (i.e., Manager, Owner, President, Principal, Agent, etc.). Mr., Mrs., Ms., agency name, or person's name are NOT acceptable business titles.
  • E-mail Address: Enter the e-mail address of the witness. It will not be used for marketing or sales purposes and will not be sold to other businesses. Be assured that it will be held in the strictest confidence.
  • Witness Phone: Enter the business telephone number of the witness.
  • Witness Fax: Enter the fax telephone number of the witness.
Sponsor Information

To order reports from LexisNexis, you are required to have a sponsoring company. You must provide the name and agency ID code of at least one sponsoring company.

If you need additional information or assistance with any of the fields on the application, contact Customer Support at 1.800.456.6432.