Renewal Forms

To renew your registration, please submit the following by September 1, 2018.


1.              Current balance sheet and income statement. 

2.        Enclosed please find the attached Faithful Performance Verification Form which documents your compliance with the faithful performance requirements of W.S. § 26‑49‑103(d). Faithful Performance Verification Form - (renewal due September 1, 2018)

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. Please return a copy of the enclosed invoice with your check.
4.        A complete itemized listing of service contract forms including form name, form number and edition date.
5.         If you have changed insurers, a copy of the new reimbursement liability policy will need to be sent to Mavis Earnshaw for approval. 


PLEASE NOTE: Regarding any changes to the reimbursement liability policy the Department must be notified at least 45 days prior to the change and a copy of the policy must be received for the Department’s 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 Mavis Earnshaw at (307) 777-6884, or email