Get Associate Membership Application - Independent Insurance Agent

Completing the Associate Membership Application for Independent Insurance Agents online is a straightforward process. This guide will provide you with step-by-step instructions to ensure that you fill out the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the organization name in the designated field. Ensure the name is accurate and exactly as it appears in your records.
3. Next, provide your organization’s web address in the appropriate space. This ensures that the application can be verified.
4. Identify the nature of your organization by checking the correct box: Insurer, Wholesaler (not Mo), Vendor, Retail Agency (not Mo), or Other. For 'Other', include a brief specification.
5. Fill out the sections for the three individuals who will receive the mailings. For each person, provide their name, designations, organization name (if different), and complete mailing and street addresses, including city, state, and zip code.
6. Enter the contact information for each individual, including phone number, fax number, and email address.
7. Indicate the Associate Membership Dues. Confirm the amount of $500.00 is accurate and note any additional MAPAC contributions if applicable.
8. Select the payment type from the options provided: Check, VISA, MC, or AmEx. Complete the billing address information as required.
9. If applicable, fill in the credit card number, expiration date, verification code, and cardholder signature. Make sure all details are correct for processing the payment.
10. Review the membership terms to ensure understanding and compliance. Sign and date the application, providing your name and title.
11. Once all fields are completed, save your changes. You may then download, print, or share the completed form as needed.

Complete your Associate Membership Application online today to ensure you don't miss out on any membership benefits.