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 - original or copy.
6. A check for $110.00, made payable to Illinois State License Holding Company (or ISLHC).
**The Referral Agreement is yours to keep for future referrals. It can be found in the Policy & Procedures Manual.
Mail the requested items to:
Illinois State License Holding Company, Inc.
P. O. Box 286
Grayslake, IL 60030