Date:

Great West Life Insurance Co.
10111 Richmond Ave., Suite 400
Houston, TX 77042

To whom it may concern,

This letter appoints TexStar Benefits, as Exclusive Broker of Record for , Contract # . They have full authority to obtain and evaluate proposals, recommend changes and otherwise handle the service of this contract. I understand that they will also be receiving all future commissions on our account for their service.

This appointment is to be effective with the date of this letter.

This appointment will remain in effect until revoked, in writing by an appointed officer of this firm.

Thank you,