Step 1: Your Information
First Name:
Middle Initial:
Last Name:
Street/PO Box:
Street Line 2:
Daytime Phone:
E-mail address:
Retype E-mail address:

Step 2: Type of License Issued Agency Licenses (select one)
(see File Specifications, opens in new window)
  • All Agencies (Includes all lists below) - $100 (file size ≈ 1Mb - 3Mb)
    • Agencies with L/H/V Affiliated Agents Only - $50 (file size ≈ 1Mb - 2Mb)
    • Agencies with P&C Affiliated Agents Only - $50 (file size ≈ 1Mb - 2Mb)
    • Agencies with Limited Line Affiliated Agents Only (Title, Crop, Travel, Bail Bonds, Self-Service Storage) - $50 (file size ≈ 1Mb - 2Mb)

Step 3: Residency Residency Status (select one)

Resident Only | Resident & Nonresident

Step 4: Payment Method of Payment (select one) (Transactions are subject to a Convenience Fee)

Credit Card | E-Check

K.S.A. 45-230 states, in pertinent parts, as follows: "(a) No person shall knowlingly sell, give or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in or derived from public records except: [see statute link for exceptions]. (b) Any person subject to this section who knowingly violates the provisions of this section shall be liable for the payment of a civil penalty in an action brought by the attorney general or county or district attorney in a sum set by the court not to exceed $500 for each violation."