Georgia Industrial Loan Association
Application for Membership

Georgia Industrial Loan Association
P O Box 801, Macon, GA  31202-0801
(478) 746-3868  Fax:  (478) 743-8278

Applying for:
Regular Membership (License# )
Associate Membership

I, (Name & Title)

of the (Company)

(Mailing Address)

(City, State, Zip)

(Phone / Fax)

(Email)

do hereby apply for membership in the Georgia Industrial Loan Association (a non-profit Trade Association).  I am mailing a check to the above address in the amount of 6 months - $110.00 12 months - $220.00 in payment of dues to Georgia Industrial Loan Association.

I shall make an effort to attend the meetings of the Association, upon notification of the time and place.  You may address all communications in the future to the above address, to my attention, and unless otherwise notified, I will represent my firm in all Association affairs.

I understand that all offices under management or ownership (in Georgia) must also become dues paying members in order to qualify this application for membership.  However, members with multiple officers, shall not be required to pay dues beyond the maximum numbers of 42 branches.

I pledge my complete cooperation and support of the efforts of the Georgia Industrial Loan Association and will uphold the constitution and by-laws as set forth by the Board of Directors.  I will also conduct my business in a way that reflects positively on the credit industry and will set an example, as to discourage the practice of unethical behavior for myself, my employees, and my competitors, as described in the Code of Ethics.

(Signature)                                                   (Date)

References for companies applying for regular membership:

Credit Insurance Company:
Representative:

For all applicants:

Industry Affiliation
List two references in the credit industry to whom you are personally know:

(Name)                         (Company)

(Name)                         (Company)

Business References
List any other business associations (local, state, national) to whom the business is a member.

(Name)                         (Contact)

(Name)                         (Contact)

What is the nature of your business (Consumer lending, Auto Financing, Real Estate, Banking, Vendor, etc.)

Endorsers
List two members who will endorse this applicant for membership

(Name)                         (Company)

(Name)                         (Company)