Membership Forms

 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, we will contact you for your holding fee via debit   or credit card once we receive everything in its entirety.

 Our new member forms:

      New Member Form.pdf                                    

       Policy and Procedures.pdf             


 **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 












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