Online Office Information Change Form

IVAR Office Information Change Form

Use this form to notify IVAR of changes in your Office contact information.

Action Being Taken: (check all that apply)*
- New Manager
- New Broker
- Add New Office
- Add Branch Office
- Make a change to an Office
Effective Date of Change*
Date Format: MM slash DD slash YYYY
New Office Manager Name:
New Broker Name:
New Email:
Enter Email Confirm Email
New Office Name:
New Website:
New Office Telephone Number:
New Office Fax Number:
New Office Address:
Street Address City State ZIP Code
I agree that IVAR should update the information as stated above:*
- Yes
- No
Name of Authorized Manager/Broker:*
The email address of Authorized Manager/Broker:*
Enter Email Confirm Email