Join the Independent Insurance Agents and Brokers of Arizona as an Associate Member and start receiving your benefits now!

Transcription

1 Join the Independent Insurance Agents and Brokers of Arizona as an Associate Member and start receiving your benefits now! Up-to-date information on Legislation, Regulation and Industry Trends, that will affect the P&C and Life & Health Insurance Industry on a State and National level. Membership Directory which lists all property and casualty member agencies in Arizona, along with the associate members, and your listing will be in the next issue released in January $300 Discount to Exhibit at one of the largest Insurance Trade Shows in the West. August 22, 2013 at the Renaissance Glendale Hotel & Spa in Glendale, Arizona. Discounted Advertising - Advocacy Networking Opportunities Discounted and Free Educational Seminars and much more! Visit our website at for more information. Enclosed is an easy one page application to join as an Associate Member. If you are interested, please complete and return it to our office with the dues. Associate Member dues are just a low $325 a year and should be made payable to IIAB of Arizona. Feel free to contact our office with any questions. Sincerely, Terri Edwards Terri S. Edwards, CIC, CISR Director of Membership Services Enclosures EXECUTIVE OFFICES 333 EAST FLOWER STREET PHOENIX, ARIZONA PHONE (602) TOLL (800) FAX (602) WEB info@iiabaz.com

2 INDEPENDENT INSURANCE AGENTS AND BROKERS OF ARIZONA, INC. A trade association to support right principles and oppose bad practices in underwriting. EXECUTIVE OFFICES 333 East Flower Street - Phoenix, AZ PHONE: OR FAX: info@iiabaz.com WEB: APPLICATION FOR INDUSTRY ASSOCIATE MEMBERSHIP IN THE INDEPENDENT INSURANCE AGENTS AND BROKERS OF ARIZONA The undersigned firm associated with the business of insurance and an exponent to the principles of the American Agency System hereby applies for Associate Membership in the Independent Insurance Agents and Brokers of Arizona. FIRM NAME ADDRESS Mailing Address City State Zip ADDRESS Street Address City State Zip PHONE FAX WEB NAME OF CONTACT # OF YEARS IN ARIZONA PLEASE DESCRIBE TYPE OF BUSINESS IN DETAIL OTHER INSURANCE ORGANIZATIONS OF WHICH YOU ARE A MEMBER ANY INTERESTING FACTS ABOUT YOUR FIRM? (professional designations, service organizations, etc.) HOW DID YOU HEAR ABOUT THIS ASSOCIATION? In signing this application for membership, I/we pledge to abide by the By-Laws of the Independent Insurance Agents and Brokers of Arizona now in force and which may be hereafter adopted; faithfully carry out the letter and spirit of the Industry Associate Member Code of Ethics (printed on the reverse side hereof) which are in part the Code of Ethics of the Independent Insurance Agents and Brokers of Arizona. DUES - The annual dues for Associate Members shall be determined each year prior to the start of the fiscal year by the Board of Directors. Currently dues are $325 annually. Dues must be paid on an annual basis and the fiscal year is November 1st to October 31st. DATE APPLICANT SIGNATURE DATE APPROVED 3rd Edition (11/04)

3 INDUSTRY ASSOCIATE MEMBERSHIP Any person, natural or corporate, partnership or association, who is in, allied with or associated with, or who is an exponent of the American Agency System, may make application for an Industry Associate Membership: and upon payment of the membership fee provided for herein, and upon compliance with such conditions as may be prescribed by the Board of Directors for membership, and upon approval of the Membership Committee and at least three (3) elected officers of the Association, may become an Industry Associate Member of the Association. Persons eligible for such Industry Associate Membership shall include, but not be limited to, the personnel of adjusting firms, general agents, credit bureaus, company special agents, insurance company service or claims offices, rating organizations, glass companies, and any other firm or organization similarly connected with the general insurance business. The Industry Associate membership list shall be published in the "Prospector," and Industry Associate Members shall be entitled to receive a ten percent (10%) discount of Prospector advertising. All privileges and obligations relating to members of this Association shall apply as well to Industry Associate Members, except that they shall not have the right to vote, attend business meetings, hold office or be chairman of a committee. They can, however, serve on any committee except the Nominating Committee. CODE OF ETHICS INDUSTRY ASSOCIATE MEMBERSHIP I pledge myself to maintain friendly relations with other firms in my community. I will compete with them on an honorable and fair basis, make no false statements, nor any misrepresentation by omission of facts, inference or subterfuge. I will consider unethical, the obtaining of business by commercial bribery, coercion or unfair influence. I will adhere to a strict observance of all laws relative to the conduct of my business and will studiously avoid any practices which might cause the business adverse notoriety or disrepute. I will cooperate in every reasonable way with my competitors for the betterment of our respective businesses and their advancement to a still higher level of service. Realizing that only by unselfish service can the insurance business have the public confidence it merits, I will at all times seek to elevate the standards of the insurance profession by governing all my business and community relations in accordance with the provisions of this Code and by inspiring others to do likewise.

4 INDEPENDENT INSURANCE AGENTS AND BROKERS OF ARIZONA CREDIT CARD CHARGE FORM Amount to be charged: $ Purchase/Service: IIABAZ Associate Membership Dues Please check one: American Express VISA MasterCard Credit Card Number: Expiration Date: / Security Code: Company Name: Card Billing Address: City: State: Zip: Phone: Name on Card (Print): Signature: Billing address is required for processing. Receipts will be given upon request only and after the charge has been processed. Yes, please me a receipt to: Fax to: Kathy Johnson at (602) OR to: kathy@iiabaz.com Mail to: IIABAZ at 333 East Flower Street, Phoenix, Arizona Please contact Kathy Johnson in Accounting if you have any questions at (602) , (800) , or kathy@iiabaz.com.

5 Independent Insurance Agents and Brokers of Arizona, Inc. 333 East Flower Street Phoenix, Arizona (602) Toll: (800) Fax: (602) AUTHORIZATION AGREEMENT FOR AUTOMATIC DUES RENEWAL I/We hereby authorize InsurBanc to initiate a debit entry to my/our ( ) Checking ( ) Savings account (select one) at Depository named below. To correct a transaction error, InsurBanc is hereby authorized to initiate an adjusting debit or credit entry to my/our depository account. This authorization is to remain in full force and effect until InsurBanc has received written notification from me (or either of us) of its termination no less than (15 ) days prior to the next transaction date to InsurBanc, 10 Executive Drive, Farmington, CT I/We acknowledge that the origination of these transactions must comply with the provisions of U.S. law. The IIAB of Arizona will charge $25.00 for any Non Sufficient Funds Transaction. Please deduct:$ Name: Business Name: Address: City-State, Zip: Phone: Name of Bank: Name on Account: Bank Routing Number: Account Number: *YOU MUST INCLUDE AN IMAGE OF A VOIDED CHECK* X Client Authorization (signature) Date Please return this completed form with a copy of your voided check to: Independent Insurance Agents and Brokers of Arizona, Inc. 333 East Flower Street - Phoenix, Arizona Fax: (602) kathy@iiabaz.com