We are excited that you have chosen to join the Client First team!

Before continuing the contracting process, please obtian a contracting code from your manager and verify that you have the following information:

  • social security number
  • tax id number (if contracting as a corporation)
  • list of non-resident state appointments
  • bank routing number
  • bank account number

By checking the box below, I agree to sign my insurance documents electronically. I agree that an electronic signature is as legally binding as if I had signed on paper. I acknowledge that I have read the Electronic Record and Signature Disclosure.

If you do not wish to sign electronically, contact your Client First Financial Group representative and we will assist you in obtaining a contract. Signing these documents electronically will not obligate you to conduct future business with the company electronically.

I Agree

HIPAA Acknowledgement

You must have reviewed and completed the HIPAA to HITECH training presentation and agree to the following:

I have completed the HIPAA to HITECH training presentation. I understand and acknowledge my legal responsibilities to safeguard personal information (PI) as required by HIPAA and the HITECH Act.
I understand my legal obligations to safeguard personal information (PI) from loss.
I understand my legal obligations to maintain anti-virus and encryption software on my personal computer if I store personal information (PI) electronically.
I understand my legal obligations to immediately notify Washington National in the event that personal information (PI) becomes misplaced, lost, stolen or is wrongfully disclosed, even if a wrongful disclosure is inadvertent or accidental.