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Site Registration 
Website Registration

Please take a few minutes now to fill out the form below COMPLETELY, and submit it.

You only need to register once.

If you have any questions, comments or problems regarding the CPS web site, please click here to send us a note.

Thank you for using the CPS Insurance Services web site.
 Registration Form
NOTE: Please make sure you use a valid email address and that it is spelled correctly.

First Name:
Last Name:
E-Mail Address:
(See Note Above)
Re-Enter Your E-Mail Address:
Create a Password:
Re-enter the Password:
Company Name:
Street Address:
Suite or Unit #:
City:
State:
Zip code:
Phone #:
xxx-xxx-xxxx
Fax #:
xxx-xxx-xxxx
Your CPS Office:
Your Account Affiliation:
(if applicable)
Do you market Annuities?:
Yes    No 
Do you market LTC?:
Yes    No 
Are you securities licensed?:
Yes    No 
If yes who is your broker dealer?:

As a CPS website user, you are included in the CPS email distribution list.  Upcoming web conferences and meetings, a regular e-newsletter, carrier and product marketing, and other important news is included in the emails you will receive.  Please proceed with the website registration process only if you understand this benefit will automatically be provided to you.

 



18551 Von Karman Ave., Suite 150 / Irvine, CA 92612
Phone 949.863.0700 Fax 949.863.9318

The CPS Insurance Services web site is maintained exclusively for active producers contracted with carriers through CPS, and is intended for agent use only. All information is intended for use as a guide, or as reference, and is believed to be current as of the date of its posting. Any misrepresentation of the information contained in the CPS Insurance Services web site by its users is strictly prohibited.

The list of registered CPS web site users is reviewed for business-related activity on a regular basis. Only registered users will receive site support of any kind. Comments and suggestions are encouraged.

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