DIRECTORY LISTINGS FORM

(Insurance Bar - Claim Service Guide - Independent Agent Handbooks)

Action Requested:
New Listing
Update Listing
Delete Company
* Required
* Company Firm Name:
Please note: Fill out the top portion of this form including e-mail and website. For the remaining sections, supply only the information you want added, changed or deleted. If extra lines are needed to complete your request in any section, please print this form, then submit by fax or mail. Use as many forms as necessary.
Address:
City:
State:
Zip:
Phone:
Fax:
* E-mail:
Website

Attorney Listing Form

Key Personnel (Name and Title)
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#1
Name and Title
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Delete
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#2
Name and Title
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#3
Name and Title
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#4
Name and Title
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Practice Description (New or updated; complete as it is to appear):

Adjusters Listing Form

Key Personnel (Name and Title)
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#1
Name and Title
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#2
Name and Title
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#3
Name and Title
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#4
Name and Title
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Practice Description (New or updated; complete as it is to appear):

Experts/Consultants, Appraisers & Property Listing Form

Key Personnel (Name and Title)
Add (After Name)
Delete
Change
#1
Name and Title
Add after
Delete
Change
#2
Name and Title
Add after
Delete
Change
#3
Name and Title
Add after
Delete
Change
#4
Name and Title
Add after
Delete
Change
Practice Description (New or updated; complete as it is to appear):

Independent Agents/ MGA's/ Brokers Listing Form

Key Personnel (Name and Title)
Add (After Name)
Delete
Change
#1
Name and Title
Add after
Delete
Change
#2
Name and Title
Add after
Delete
Change
#3
Name and Title
Add after
Delete
Change
#4
Name and Title
Add after
Delete
Change
Practice Description (New or updated; complete as it is to appear):
Other Requests:
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