Florida Association of Insurance Agents

Package Pricing for Webinars
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Company Information:
*Contact Name:
*Company Name:
Address:
City:
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How did you hear about our package pricing?	On the Web FMS Rep Other
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Enter number of Webinar hours:

50-99 Hours - $22 per hour 100+ Hours - $19 per hour *Number of hours:

Credit Card Information:
*Credit Card:	Select One Master Card Visa
*Credit Card No:	---
*V-Code:
*Expiration Date	(mm/yy)
*Credit Card Billing Address:
*City:
State:	Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
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