SPBA 2008 Survey of Third Party Administrator
Licensing Statutes
Order Form
Date _________________
Send Directory to:
Name _________________________________________________________________
Company Name _________________________________________________________
Address ________________________________________________________________
City ___________________________ State ________ Zip _______________________
SPBA 2008 Survey of Third Party Administrator
Licensing Statutes $500.00
(SPBA's strict independent audit process
requires that this form be accompanied by a check,
there is no faxing or on-line ordering, you may not use a credit card)
We send the Survey to you via priority mail as soon as we receive your check.
Please send this form and your payment to
SPBA
Two Wisconsin Circle, Ste. 670
Chevy Chase, MD 20815
Questions: Call 301-718-7722 or email spba@erols.com