Agent Registration – Louisiana Defensive Driving

Insurance Agents

If you would like to sign up for an Agent Account, please fill out the information below. Your agent account provides access to a personalized dashboard and allows you to receive completion certificates for your clients via email.

Step 1: Agent Information

Agent's First Name:

Agent's Last Name:

Agent's Email:

Agent's Phone:

Agency: (ex: State Farm, Allstate, Farm Bureau, etc.)

Mailing Address: (to receive supplies for your office)

Street Address:
City:	State:	Zip:

Step 2: Agent Portal Login Credentials

Login Credentials

List the name and email address of each additional person in your office who should receive login credentials to your agent dashboard. Do not include the contact person from step 1. (Their account will be created based on the information above.)

(Click on +Add New to add more contacts.)

First Name:

Last Name:

Email:

Step 3: Certificate Completion Emails

Completion Certificates

List the email address of each additional person in your office who should receive completion certificates for your clients via email. Do not include the contact person from step 1. (Their account will be created based on the information above.)

(Click on +Add New to add more contacts.)

Email:

*Please note that the sign up form above is for Insurance Agents only. If you are an insurance client and are attempting to register for the Defensive Driving course, please click on the Purchase Course link in the top navigation menu.