Step 1: Your Information
First Name:
Middle Initial:
Last Name:
Organization:
Street/PO Box:
Street Line 2:
City:
State:
Zip:
Daytime Phone:
E-mail address:
Retype E-mail address:

Step 2: Type of License New License Qualifications (select one)
    Agent
  • All New Agent Licenses (Includes L/H/V, P&C, and Limited Lines) - $50 (file size ≈ 1Mb - 3Mb)
    (see File Specifications, opens in new window)
    Agency
  • All New Agency Licenses (Includes L/H/V, P&C, and Limited Lines) - $50 (file size < 1Mb)
    (see File Specifications, opens in new window)

Step 3: Residency Residency Status (select one)

Resident Only | Resident & Nonresident


Step 4: Time Frame Licenses Issued in Past: (select one)

90 Days | 180 Days


Step 5: Payment Method of Payment (select one) (Credit Card transactions may be subject to a Convenience Fee)

Credit Card | E-Check



K.S.A. 45-230 states, in pertinent parts, as follows: "(a) No person shall knowlingly sell, give or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in or derived from public records except: [see statute link for exceptions]. (b) Any person subject to this section who knowingly violates the provisions of this section shall be liable for the payment of a civil penalty in an action brought by the attorney general or county or district attorney in a sum set by the court not to exceed $500 for each violation."