Insurance Consumer Advocate Network: SPONSOR REGISTRATION FOR RENT-A-CAR SERVICE

Sponsor Registration Form

(Rent-A-Car Service)

* Required field
* Business name:
* First name:
* Last name:
* Mailing address:
* City:
* State:
* Zip:
Country:
* Phone #1:
Phone #2:
Fax:
* E-mail address:
Existing Web site URL:
Referred by:	Existing iCan Affiliate

* Would you be willing to include (at your option) vehicle Post-Repair Diminished Value Documentation as part of your client's Personal Injury Settlement Demand Package ?

Yes
No

Become Listed
I / We choose to participate based upon a $300.00 annual listing fee ... as expressed in the "Terms & Conditions" published (and printable) below.

This is an SSL Secured Transaction ...
    Transaction Amount: $300.00
    Credit Card Number:
    Expiration Date:

[ OR ]

Please Contact Me for Potential "Custom" Terms & Conditions !

Please link my (our) listing to:

Above E-mail
Above Website
Both
Do NOT Link

List any Professional Association Memberships
and/or Certifications here:

Terms and Conditions:

It is acknowledged that Insurance Consumer Advocate Network, LLC, herein after referred to as "I-CAN" (1085 S. Red Cedar Avenue, Springfield, MO 65802 / 417-831-6133 Office) is the owner and operator of an Internet Web site identified as www.ICAN2000.com. Said Web site is designed to be a Nationally Accessible and  Locally Relevant source of information for Insurance Consumers. 
Web site visitors are able to access Self-Help Text (published with permission of J.D.Howard) on the negotiation and settlement of Auto, HomeOwner and/or Personal Injury Claims.

The I-CAN Web site is a means by which visiting consumers may identify "Local Help Advocates" that could provide assistance in resolving issues related to Auto, HomeOwner and/or Commercial Insurance contracts. Sponsor affirms they are properly licensed and insured. Sponsor further affirms they will remain properly licensed and insured throughout the term of this agreement.

Sponsor understands that I-CAN will be publishing Sponsor's contact information on their Web site where it can be easily accessed by visiting consumers.

Sponsor acknowledges it is the intent of I-CAN to list only the most dedicated professionals on our Web site. As such, Sponsor acknowledges that I-CAN may (at the option of I-CAN) abrogate this agreement and refund sponsorship fees (pro-rata) if Consumer Complaints to I-CAN (and the subsequent investigation of those complaints) reveal a pattern of conduct which I-CAN chooses not to endorse.

Sponsor has the right to abrogate this agreement, at any time, and receive a pro-rata refund of sponsorship fees less a per listing re-programming fee.

Sponsor's Published Listing(s) will be Linked to Sponsor's own existing or future Web Page or Web Site and/or pre-addressed E-mail template at the option of Sponsor. Changes in listings and/or links will be done at no charge as requested within six (6) months of inception of this agreement. Later changes will be subject to a re-programming fee.

OUR PLEDGE:
In addition to the Promises set forth above, I-CAN pledges to ...
•  Continue to Promote our Web site to consumers and media elements, both On-Line and Off-Line, to maintain our pattern of growth ("Hit" count verification available upon request).
•  Continue active national recruitment of qualified "Local Help Advocates" who compliment our consumer advocacy efforts.
•  Network with, and support the efforts of, other agencies, associations and entities whose consumer advocacy goals are consistent with those of I-CAN.
•  Utilize our National e-mail data base of consumers and media subscribers to promote issue awareness on insurance related matters.

This agreement shall take effect on the date Sponsors' Listing is Published to the I-CAN web site and shall be perpetual until either party gives written notice to the other of intent to Abrogate this Agreement.

Printable Version

I have read, understand and agree to the Terms and Conditions expressed herein.

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