Business Liaison Transfer

Under the terms of ACA Business Affiliation, individual benefits are transferable ONLY to the business's liaison (Individual membership) of the Business Affiliation. The business can transfer the balance of this Liaison (individual) membership to another named person by completing the form below:

Business

Company Name

ACA Business Affiliate ID #

Former ACA Liaison Information

We must have a forwarding address for the former liaison, otherwise mailings will continue to their former address.

Former ACA Liaison Name

ACA Member ID #

Forwarding Address

City, State, Zip

This address is my

Home

Work

Phone

E-mail

Will this individual remain with the business listed above?

Yes

If so, please indicate if their ACA membership should continue

Yes

If ACA Membership is to continue, we will send a renewal invoice. If membership is not to continue, former liaison's membership will lapse immediately.

New ACA Liaison Information

Name

ACA Individual Member ID #

This address is my

Home

Work

City, State, Zip

Phone

New E-mail

Form Completed By

Name *

Phone *

E-mail *

By submitting this form, you accept the Mollom privacy policy.

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