Renewal Forms

To renew your registration, please submit the following by September 1, 2019.


1.              Current balance sheet and income statement. 

2.        Faithful Performance Verification Form - (renewal due September 1, 2019) W.S. § 26‑49‑103(d).

3.        Annual renewal fee of $200 payable to the Wyoming State Treasurer and mailed to the Wyoming Insurance Department, 106 East 6th Avenue, Cheyenne, WY 82002.
4.        A complete itemized listing of service contract forms including form name, form number and edition date.
5.         If you have changed insurers, please include a copy of the new reimbursement liability policy for approval. 


PLEASE NOTE: The Department must be notified at least 45 days prior to any changes to the reimbursement liability policy.  A copy of the amended policy must be submitted for Department review and approval.

In order to do business in Wyoming you are required to be registered with the
Wyoming Secretary of State and maintain that registration. Please contact their office at (307)
777-7311 for registration information. Registration will be verified at renewal; if you are not in
compliance, your service contract provider registration will not be renewed.

If you have any questions, please contact Tammy Higgins at (307) 777-6884, or email