* Indicates Required Field |
Please complete the following information. Although not all items are required, the more information you provide us, the better
we can answer your question.
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First Name * |
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Middle Initial |
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Last Name * |
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Email Address * (this is where we will email our response) |
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Telephone Number * |
(###-###-####)
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Alternate Telephone Number |
(###-###-####) |
Licensee Name |
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| (First, Middle Initial, Last) |
Subject of Inquiry: To ensure that your request for information is being referred to the
appropriate staff for processing, please select a topic from the drop down menu below that most
closely relates to the subject of your inquiry.
Adjuster/Bail inquiries: Select "Adjuster" or "Bail" from the drop down box for ANY
information pertaining to that license type, including licensing information, status of pending
applications or renewals, and any training or educational requirements.
Business Entity (Agencies): Select "Business Entity" from the drop down box for ANY
information regarding the licensing of corporations, partnerships, or limited liability Companies,
including information on the status of pending applications. Also select this topic
if you are inquiring about information pertaining to the use of a fictitious name or DBA.
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Subject of Inquiry * |
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License Number |
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SSN or FEIN (last 4) |
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Comments/Questions/Complaints (please be specific) * |
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