Complete the form below to become an American Agents Alliance Member today. Member dues are based on the number of staff members per location and billed month-to-month.
Please note: You will not be billed until we have approved your membership.
I/We authorize the American Agents Alliance (The Alliance) to initiate debit entries and to initiate and credit entries and adjustments for any debit entries
in error to my/our account indicated and the necessary depository financial institution names on attached voided check or credit card (hereinafter called Depository) to debit and/or credit the same to such account. I/We acknowledge that the origination of ACH/EFT transactions to my/our account must comply with the provisions to U.S. Law. This authorization is to remain in full force
and effect until The Alliance has received written notification from me/us of its termination in such time and in such manner as to afford The Alliance and Depository a reasonable opportunity to act on it.
Only fill in if you are not human
Please contact us at: firstname.lastname@example.org 866 497 9222