New Agent & CPA Registration

Please fill out the form below to register as an Agent or CPA with American Health Value.

As soon as you've registered you'll receive an email from us containing several important pieces of information, including:

  • Your Username/Temporary Password
    • Allows access to our closed agent section & marketing materials

  • Your Unique Broker ID
    • Allows us to track your commissions

  • Your Unique URL
    • Automatically embeds your Broker ID in our online application for commission accuracy
If you have any questions, please don't hesitate to contact our office and we would be more than happy to help you in any way we can. We look forward to working with you and finding the best way to serve both you and your client base.
Online Payments

*Note: All fields marked with an asterisk (*) are required.
*First NameMI*Last NameAgency Name*Address*City*State*Zip Code*Work PhoneCell PhoneFax Number*Contact Email*SSN or Tax ID (Required for Commissions)*What is your line of business?


(If other, please specify)*Do you have a website?
Website URL*How did you hear about us?