Partner Membership Application – Insurance Agents & Brokers

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IA&B Partner Membership Application

Company Information
Company Name (as it should appear in publications)
Street Address
Street Address Street Address Line 2 City State ZIP Code
Mailing Address
Mailing Address Mailing Address Line 2 City State ZIP Code
Company Type
- Insurance Company
Contact Information
Primary Contact Name
First Middle Last Suffix
Mailing Address
Mailing Address Mailing Address Line 2 City State ZIP Code
Phone
Email
Organization Role
If licensed, please provide the following:
Resident License State
State
Resident License
NPN
Birth Date
MM slash DD slash YYYY
Secondary Contact Name
First Middle Last Suffix
Mailing Address
Mailing Address Mailing Address Line 2 City State ZIP Code
Phone
Email
If licensed, please provide the following:
Resident License State
State
Resident License
NPN
Birth Date
MM slash DD slash YYYY
Marketing/PR Contact Name
First Middle Last Suffix
Mailing Address
Mailing Address Mailing Address Line 2 City State ZIP Code
Phone
Email
Partner Level
Please Choose a Partner Level
- Platinum Partner: $7,500
- Gold Partner: $5,000
- Silver Partner: $2,500
Questions?
Contact Tim at TimW@IABforME.com or 800-998-9644, ext. 351.
Fine Print
Partner sponsorships are pro-rated February through December. For current rate, call Tim at 800-998-9644, ext. 351.

Promotion benefit cycle will begin within 60 days of program registration approval. Partner benefits will be in effect through the end of current year. Based on your join date, your benefits could vary.

The Association reserves the right to exercise its sole discretion in acceptance/refusal of partner applications. If an application is not accepted by the Association, all money paid will be returned to the applicant.

Terms & conditions for IA&B Partners Program
Applies to new applications and renewal invoices

1. Partnership Terms

The partnership year shall be from January 1 through December 31 and is subject to approval. Partner sponsorships are pro-rated February through December 31. When your partnership application or renewal is submitted, you are making an offer to join IA&B which, if accepted by us, will result in a legally binding contract. A legally binding contract is formed when IA&B accepts your application or renewal. Promotion benefit cycle will begin within 60 days of program registration approval. Partner benefits will be in effect through the end of current year. Based on join date, partnership benefits could vary.

If you cancel your partnership within 14 days of submitting your partnership application, we will refund any partnership fee that you have paid in the last 14 days. There is no refund allowance, part or in full, after this time.

2. Resignation and transferring of partnership

Partnership dues are non-refundable. A partner may resign by filing a written resignation with the Association, signed by the agency’s Primary Partner. Such resignation shall not relieve the partner of any dues or charges which have theretofore accrued and remain unpaid. Partnership, and any rights and benefits arising therefrom, may be transferrable upon sale or merger of the partner company, upon approval of IA&B.

3. Authorization

I consent to the receipt of e-mails and other correspondence sent to my office and additional locations from IA&B and IA&B Service Group. I have the right to opt out of receiving emails at any time. I certify that I have the authority to provide such consent on behalf of my organization.
Acceptance of Terms & Conditions
Acceptance of Terms and Conditions
- I accept all IA&B Terms & Conditions
Signature

TO BE ELIGIBLE FOR MEMBERSHIP, AN AGENCY MUST:

National Affiliation

PA & DE members are affiliated with the Independent Insurance Agents & Brokers of America (IIABA).

MD members are affiliated with the National Association of Professional Insurance Agents (PIA)

Membership Information

Dues are based on the number of full-time staff (20 or more hours a week) on record and verified annually. The total number of staff includes staff at all locations of the agency as well as the owners.
Membership year is 365 days from the date of application.
Membership is subject to approval.
A portion of IA&B membership dues are deductible as ordinary business expenses under the Internal Revenue Code; however, dues may not be considered as charitable contributions.
Dues are subject to change.
There is no refund allowance, part or in full, for membership dues.
By submitting payment for membership dues, you are deemed to have accepted and be bound by the terms and conditions of membership outlined at IABforME.com/Membership_Terms.

5050 Ritter Road
Mechanicsburg, PA 17055

191 Main Street
Annapolis, MD 21401

Toll Free: 800-998-9644
Fax: 717-795-8347
Email: IAB@IABforME.com

Get Connected

IA&B Partner Membership Application

Company Information

Contact Information

If licensed, please provide the following:

If licensed, please provide the following:

Partner Level

Questions?

Fine Print

Terms & conditions for IA&B Partners Program

1. Partnership Terms

2. Resignation and transferring of partnership

3. Authorization

Acceptance of Terms & Conditions

TO BE ELIGIBLE FOR MEMBERSHIP, AN AGENCY MUST:

National Affiliation

Membership Information

Dues Calculator

Annual Dues:

Monthly Dues: