Western Carolina Claims Association
Membership Application

formerly Asheville Claims Association
 
 Date_____________ ____New ____Renewal

Name of Applicant_______________________

Home Address__________________________

Home Phone___________________________

Employer______________________________

Job Title_______________________________

Business Address________________________

Business Phone__________________________

Description of Job________________________

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Adjuster Membership Dues $10.00

Associate Membership Dues $35.00

Mail to:

PO Box 1327 Candler, NC 28715