Member in good standing of:
of the above
Your Name & Title
Appointment Phone Number w/Area Code or
800 number to appear in Directory.
Executive Office Phone Number w/Area Code
Executive Office Fax Number w/Area Code
Primamry Offfice - Street Address
Primary Office - City, State, Zip Code
Place code(s) beside each State BELOW where you do business. By applying
for a listing you CERTIFY that you conduct business from at least 9 a.m. to 6 p.m.
in a particular State and that you are licensed by that particular State, if required.
A- By appointments
for office visits
C- Counseling over 800 number
F- Internet Form collecting "secure" DEBT data.