DIRECTORY ORDER FORM

* Required
* Name:
Title:
Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
* Email:
Business Description:

Enter number of directories to be ordered:

Insurance Bar ($99.00 each)
Claim Service Guide ($99.00 each)

Independent Agent Handbooks

AL/FL/GA Independent Agent Handbook ($99.00 each)
AR/LA/MS Independent Agent Handbook ($99.00 each)
CT/ME/MA/NH/RI/VT Independent Agent Handbook ($99.00 each)
IA/MN/NE/ND/SD Independent Agent Handbook ($99.00 each)
IL/IN Independent Agent Handbook ($99.00 each)
KS/MO/OK Independent Agent Handbook ($99.00 each)
KY Independent Agent Handbook ($99.00 each)
MI/WI Independent Agent Handbook ($99.00 each)
NC/SC Independent Agent Handbook ($99.00 each)
NJ Independent Agent Handbook ($99.00 each)
NY Independent Agent Handbook ($99.00 each)
OH Independent Agent Handbook ($99.00 each)
PA Independent Agent Handbook ($99.00 each)
TN Independent Agent Handbook ($99.00 each)
TX Independent Agent Handbook ($99.00 each)
VA/DE/DC/MD/VA/WV Independent Agent Handbook ($99.00 each)

Payment:

Enclosed (Print the form & mail with check)
Credit Card (Submit the form & we will contact you)

Complimentary Distribution

Complimentary distribution is limited to claim managers, supervisors, self insureds, etc. for use in claim assignments and legal referrals.

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