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Agent Registration
Agent Registration
Welcome to DAC Agent Registration! If you are an authorized DAC agent, please fill out and submit the short form below.
Enter your vital information beginning with your DAC Agency number, your e-mail address and account password.
If you need assistance, please contact
Atina Kroh
at DAC via e-mail or telephone at 1.800.444.3584
Create a new account
Agency Number
Agency/Agent Name
Agency Contact Name
Agent Email Address
Agency Address Line 1
Agency Address Line 2
Agency City
Agency State
Agency Zip Code
Password
Confirm Password