TAPIA Membership Application Instructions Thanks for your interest in TAPIA membership! After you have entered the details below, click Next to advance through the application. Once we receive your application, the Membership Committee will begin its review of your application. PA Membership Form - New and UpdatedContact InformationLicense DetailHistory and ReferencesAttestation and PaymentChoose the type of membership Licensed Public Adjuster Non-Licensed Associated Affiliate Attorney AffiliateFirst NameLast NameSecond representative name (if any)EmailPhoneMobile PhoneWebsiteBusiness AddressAddress Line 1CityStateZip CodeBusiness PhoneWhat is the primary nature of your business?Have any complaints been filed against you with the Better Business Bureau (BBB)?If yes, please describe:Have any complaints been filed against you with or by any State/Federal authority?If yes, please describe:PreviousNextLICENSED PUBLIC ADJUSTERSThanks for your interest in TAPIA membership! Fill in the application and click Submit. The Membership Committee will begin its review of your application.TX PA License #What date was your license issued?How many years have you been a public adjuster?Are you engaged in any business other than public adjusting?- Select -YesNoIf yes, describe:Are you engaged in any way in building construction or damage restoration?- Select -YesNoIf yes, provide specifics:Have you ever been reprimanded/disciplined by any Insurance Department or State?- Select -YesNoIf yes, provide specifics:Has your public adjuster license ever been suspended or revoked in any state?- Select -YesNoIf yes, provide specifics:Have complaints been filed against you with or by any state licensing authority?- Select -YesNoIf yes, provide specifics including the outcome:Are you licensed in states other than Texas?- Select -YesNoIf yes, please list each state you are licensed in, including license # and year licensed.NON-LICENSED ASSOCIATE Thanks for your interest in TAPIA membership! Fill in the application and click Submit. The Membership Committee will begin its review of your application.Who is your TAPIA Public Adjuster Member sponsor?Company name?Position in company? (Job responsibilities)How long?Does this company engage in any business other than public adjusting?- Select -YesNoIf yes, provide specifics:Do you work for any other public adjusting firms in Texas or other states?- Select -YesNoIf yes, describe?Are you engaged in any way in building construction or damage restoration?- Select -YesNoIf yes, describe:Have you ever been reprimanded/disciplined by any Insurance Department or State?- Select -YesNoIf yes, provide specifics:Have complaints been filed against you with or by any state licensing authority?- Select -YesNoIf yes, provide specifics:Are you licensed as a public adjuster in any state?- Select -YesNoIf yes please list each state your are licensed in, including license # and year licensed.CURRENT EMPLOYMENTCompany nameHow long?Position in company- Select -Owner/PartnerEmployeeContractorOtherDoes this company engage in any business other than public adjusting?- Select -YesNoIf yes, provide specifics:Does this agency have a public adjuster agency license?- Select -YesNoIf yes, firm name:What year was the agency licensed?What is the agency Texas license number?How many public adjusters work in this agency?PREVIOUS EMPLOYMENTPrevious Employer/Business #1How long?EmailPhoneWhat were your responsibilities in this position?Previous Employer/Business #2How long?EmailPhoneWhat were your responsibilities in this position?PreviousNextBUSINESS REFERENCES (Provide three.)Important: Provide name, phone, email, years known, and nature of your relationship for each reference. Your application will not be processed without this information.First Reference NameFirst Reference PhoneFirst Reference Years KnownFirst Reference Nature of RelationshipSecond Reference NameSecond Reference PhoneSecond Reference Years KnownSecond Reference Nature of RelationshipThird Reference NameThird Reference PhoneThird Reference Years KnownThird Reference Nature of RelationshipPreviousNextADDITIONAL INFORMATIONHave you been a TAPIA member before?YesNoIf yes, what years?Why do you want to become a TAPIA member?List any professional associations you belong to:What interests you most about TAPIA? (Choose all that apply)ConferencesEthics & GrievancesGovernment RelationsMembershipNot interested at presentWho may we thank for your interest in TAPIA?Attorney Affiliate AcknowledgementI acknowledge that: No Attorney Affiliate member will have ownership or affiliation in a public adjusting firm. No Attorney Affiliate member will advertise as adjusters or public adjusters. No Attorney Affiliate member will have ownership or affiliation in any company that provides funding for insurance claims to property owners, adjusters or contractors. No Attorney Affiliate member will do any advertising or marketing that sheds a negative light on the public adjusting industry. No Attorney Affiliate member will be in direct competition with the public adjusting industry - for example they cannot state to hire them before hiring a public adjuster and they cannot state they are attorney-adjusters. The Attorney Affiliate member firm has an office location in the state of Texas.Attorney Affiliate Acknowledgement I agree. I do not agree.ATTESTATIONThe information provided here is true and accurate to the best of my knowledge. I give TAPIA permission to inquire into and verify all information. I understand that TAPIA’s Membership Chairperson and/or another member of the Board will contact me to discuss the member approval process. Further, I understand that TAPIA’s Bylaws allow TAPIA member organizations to review applicants and notify the Membership Chairperson if there are objections, and that I will have the opportunity to respond to any objections before a final decision is made. If my membership is approved, I will comply with the TAPIA Bylaws and rules of membership. I promise to be professional and promote good will towards fellow members.Attestation I agree. I do not agree.MEMBERSHIP PAYMENTMember Type: Registered Public Adjusters $500 ($100 discount applied):Price: $400.00Member Type: Non-licensed Associate Member:Price: $225.00Member Type: Affiliate Member:Price: $1,000.00Member Type: Attorney Affiliate MemberPrice: $2,500.00Pay with Card (Stripe) Previous Submit and Pay Online
