Producers, Request to Use Aetna Logo

For Aetna brokers: Please use this form to obtain permission to display the Aetna logo on your website or printed material, for the purpose of identifying Aetna products and services that you market.

Other logo permissions – online form

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All fields marked with a RED asterisk(*) are required in order to proceed.

*I am a current Aetna producer

Yes

IF YOU ARE A MEDICARE PRODUCER, PLEASE PROVIDE YOUR NATIONAL PRODUCER NUMBER (NPN).

* Company name

* Last name

* First name

Title

* Address

* City

*State (if US-based)

*5 digit ZIP code

Country

International postal code

Phone number

International phone number

Fax Number

* Aetna sales representative

* Email address (formatted as example@sample.com)

* Provide website address (formatted as www.website.com)

*Will the Aetna logo be associated with any Medicare offerings?

Yes

Click on the Submit button below to be taken to the Terms of Use of the Aetna logo:

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