User ID and Password Request Form
To request a user ID and password, please submit your request below. A Amwins Connect Administrators representative will respond to your inquiry within 1-2 business days.

If you have a question/concern requiring immediate assistance please contact your Amwins Connect Administrators Representative Mon.-Fri., 8:30 a.m. - 5:00 p.m. EST 1.800.638.6085.

For account or member specific questions, please click here to proceed:
Request for Information or Services.

* = ALL FIELDS ARE REQUIRED.


ARE YOU A
HEALTHPLAN MEMBER?*
YES    NO
ARE YOU AN EMPLOYER?* YES    NO
ARE YOU A BROKER?* YES    NO
NAME:*
EMAIL:*
COMPANY NAME:*
ADDRESS:*
CITY:*         
TELEPHONE:*
COMMENTS:*
© 2000-2024, Amwins Connect Administrators, Inc.  All Rights Reserved.