To Whom It May Concern:
Authorized Benefits Plans, Inc.
2131 E. Broadway Rd #24
Tempe, AZ 85282
Phone: (480) 502-6869
Fax (480) 894-9707
Authorized Benefit Plans, Inc. is to become our Broker-of-Record
effective immediately on the insurance policy indicated below.
Authorized Benefit Plans, Inc., will receive compensation through
commissions of sold products and services rendered. (43-1960727)
Signature
Name (Print)
Business Name (If applicable)
Address
City, State, Zip Code
Phone Number
Email Address
Insurance Company
Policy Identification Number
Date
* Please copy to Company Letterhead - if applicable
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