IIAOK Partner Program Commitment Form
Thank you for your interest in the 2019 Partner Program. Because of you, the Independent Insurance Agents of Oklahoma is able to make a bigger impact in the independent agencies across our state.

If you have any questions concerning partnership, please contact Shania Slavick at shania@iiaok.com

Completion of this form will reserve your space in the 2019 Partner Program.

Company Name: *
Your answer
Company Contact Name: *
Your answer
Company Contact Email Address: *
Your answer
Invoice timeline: *
Note: invoice timeline does not determine location on partner listing, it merely lets us know when you'd like to be invoiced.
Partnership Level *
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