Blue Shield Application Upload

Fax or Upload your Blue Shield Application to Bridlewood Corporate for review.

Fax: 815-572-0924

Blue Shield - Agent Application Upload

*** AGENT PERSONAL NPN # - Please provide your personal NPN #, NOT your corporate NPN # in this field. Blue Shield only allows for ONE corporation to be listed, which is Bridlewood's EIN #, and ONE individual/agent. IF you list your corporate NPN #, the commission will not be paid to the agent, and Bridlewood will not be credited for the business. Thank you. ***
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