Producers, Request to Use Aetna Logo

(Includes an Option to Use the Aetna Logo as a Link to the Aetna.com Home Page)

For Current Producers Selling Aetna Products

Please use this form to request permission to display the Aetna Logo on your Internet site for the purpose of identifying Aetna products and services you market (with or without a link)

For all other needs, please click here.

Thank you for your interest in using the Aetna Logo. We would like to gather some basic information from you for our records. Upon submission of this form, and your agreement to be bound by the Terms of Use of the Aetna Logo, you will automatically be provided with instructions on how to download the Aetna Logo and link to the Aetna.com home page.

Please enter your contact information

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

*I am a current Aetna Producer

Yes

*Company Name

*Last Name

*First Name

Title

*Address

Country

International postal code

Phone Number

International phone number

Fax Number

*Aetna Sales Representative

*Your Email Address

*Your Website URL

*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:

Important!

Please check this form carefully before clicking on the "Submit" button. Some browsers will not keep your information, and you will have to re-type all of it if you miss filling in any of the required fields.

Your request has been sent successfully if you receive a confirmation after clicking the "Submit" button.

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Do you have Aetna insurance through an employer or are you a Medicare member? Yes No

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Do you have Aetna insurance through an employer or are you a Medicare member? Yes No

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