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AGENT REPORT

 
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Ozzie
Site Admin


Joined: 22 Oct 2005
Posts: 30
Location: Maryland

PostPosted: Sat Oct 25, 2008 8:39 am    Post subject: AGENT REPORT Reply with quote

Agent Report

If you are not receiving the Agent Report it may be because you have not made of change of address when you moved  or that you have not paid your annual dues.  Below are the forms to correct this situation and you will again be receiving that great Agent Report again.

Do You Have A New Address?                                              
Membership Number (s) ___________________________

Full Name (s) ____________________________________

Address:_________________________________________

City ____________________________________________

State______________ ________________Zip __________

Phone __________________________________________

E-Mail Address (If any)____________________________

Clip and send to Stan Solin, Stan Solin;
P.O. Box 31-111
Anaheim, CA 92809
or e-mail
agentreport@gmail.com

ACICV ANNUAL MEMBERSHIP DUE (Annual Dues $25.00 per household)  
Member Number(s) _______________________________

Name (s) ________________________________________

Address______________________________________________________

City, State, Zip ______________________________________________

Telephone Number (_____)______________________________

Email Address (if any)________________________________________

Annual dues payable NLT 31 March .

MAKE $25.00 CHECK TO ACICV, INC    AND MAIL TO:   MICHAEL SCHLENOFF, 28 PARKWAY DRIVE, SYOSSET, NY 11791-6618

For Office Use

Amount Paid $___________ Check # _______ Dated_______
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