Apply for Membership to Texas Public Insurance Adjusters Forum

Texas Public Insurance Adjusters Forum Membership Application

To become a member, you must first fill out the following membership application and be approved by the forum’s moderator. Please fill out the application form found below.

Keep the following key points in mind:

• You MUST be a licensed public insurance adjuster or an attorney that can prove that your practice is dedicated solely on the behalf of Texas consumers
• All of the application’s fields are REQUIRED
• Incomplete applications will be discarded
• All Texas Public Adjuster licensure information is verified through the Texas Department of Insurance before anyone will be granted membership to the Texas Public Insurance Adjusters Forum.

Our private online community consists of like-minded public insurance adjusters and attorneys committed to public service in Texas. If you do not meet our criteria, you need not apply.

Please exercise patience as we review your membership application and verify your Texas PA license status. We respect your privacy and will not share your membership application information with any third parties. We will contact you with your forum login credentials upon membership approval.
Thank you for applying, and we look forward to having you as a member of our forum.

First Name:
Last Name:
Email:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Zip Code:
Telephone:
If you are an attorney or out of state Public Insurance Adjuster please list any professional references or other information that can be used in the consideration for the approval of your application.
Occupation:
State of Licensure:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
License/Bar Number:
	Please leave blank: Enter Security Code:
If you experience any problems with the website please contact Stephen Hadhazi, the forum moderator at patx@docudamage.com

Texas Public Insurance Adjusters  2010 All Rights Reserved