Site Registration 
Website Registration Please take a few minutes now to fill out the form below COMPLETELY, and submit it. Your User ID and Password information will be emailed automatically within minutes.

You only need to register once.

Thank you for using the CPS Insurance Services web site.


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.