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IMPACT PLEDGE CARD


Why Contribute?

Please remember, a contribution is not considered a business expense by the IRS, so it is not deductible.
*BY FILLING OUT THIS FORM, YOU ARE CONTRIBUTING TO IMPACT
I pledge:
An individual contribution of $100 An individual contribution of $
An agency contribution of $  
TOTAL CONTRIBUTION: $
Check one:
Please bill me for my pledge.  
Please charge my credit card. MasterCard Visa
Card Number: - - - Expiration Date:
Name on Card:
Name:
Agency:
Mailing address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
Please add my name to FAIA’s grassroots network.
Please ask me about my relationship with my local legislator.
FAIA
P.O. Box 12129
Tallahassee, FL  32317-2129
Phone: 850-893-4155 ext. 369
Fax: 850-668-2852
Staff: Kyle Ulrich







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Mission Statement:  To serve Florida insurance agents by promoting a healthy and competitive insurance environment.

3159 Shamrock South * P.O. Box 12129 * Tallahassee, FL 32317-2129 * Tel: 850.893.4155 * Fax: 850.668.2852
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