INSURE YOUR FUTURE

INSURE YOUR FUTURE

PLEASE NOTE: THERE IS NO NEED TO DOWNLOAD SMARTSHEET APP TO COMPLETE THIS CONTRIBUTION FORM.

By making a contribution, you are making an investment into the future of independent insurance agents.

ALL CONTRIBUTIONS MUST BE MADE BY PERSONAL CHECK OR PERSONAL CREDIT CARD. COMPANY OR AGENCY ACCOUNTS CANNOT BE USED.

Click here if you wish to use a printable downloadable donation form.

You referred to this form by?*

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First Name*

Last Name*

Are you a Young Agent of Oklahoma?*

Yes

No

Agency

Occupation

Address*

Phone

Phone

City*

State*

Zip*

Email

Level

$5,000 - Millennium Level

$2,500 - Platinum Level

$1,000 - Centennial Level

$500 - Gold Level

$250 - Pioneer Level

$150 - Founders Level

$100 - Young Agents Level

OTHER

GIFT TO*

OKPac

InsurPac

PLEASE NOTE:

Contributions or gifts to OKPac or InsurPac are not deductible as charitable contributions for purposes of federal income tax. Federal and State law require IIABA and BIGiOK to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each individual. Your contribution should be considered strictly voluntary. Any corporate contributions are prohibited.

By clicking submit button below, you have freely and voluntarily given from your personal property. You have not, directly or indirectly, been compensated or reimbursed for the contribution listed above.

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