Broker Form


Thank you for becoming certified with beWellnm. We support our New Mexico Agent and Broker Community. We want to let you know we look forward to growing our partnership and your business. Please fill out the form below to establish a profile on our beWellnm.com website or make any changes to your existing profile on the website and SHOP portal (if applicable). If you are SHOP certified you will also be able to establish your Small Business Portal.
 
 
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(If you are an Independent Agent/Broker)
   
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This information that you have provided will be made public on the beWellnm.com website.
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If you are SHOP certified we will need the following additional information. Also provide your cell phone number for our 2-step authentication process into the SHOP portal.
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