Please send us the following:
1. New Member Form, completed.
2. W-9, completed and signed.
3. Contract Agreement, completed and signed - of the Policy & Procedures Manual.
4. Acknowledgement Form, signed - of the Policy & Procedures Manual.
5. Terminated license - copy acceptable.
6. A check for $110.00, made payable to Illinois State License Holding Company (or ISLHC).
If you prefer to email items #1 - #5 to us at firstname.lastname@example.org, we will contact you for your holding fee via debit or credit card once we receive everything in its entirety.
Our new member forms:
**The Referral Agreement is yours to keep for future referrals. It can be found in the Policy & Procedures Manual.
If you are mailing your new member packet, please send the requested items to:
Illinois State License Holding Company, Inc.
P. O. Box 286
Grayslake, IL 60030