Atlantic Claim Executives Association - ACEA

Name

Email Address

Company Name and Mailing Address

Job Title

Daytime Phone Number

Fax Number

Type of Insurance Company

Major Lines Written

Identify which Atlantic states your company operates in - check all that apply

Briefly describe the major responsibilities of your job

Representative Reports To (name and title)

Are you the most senior claims executive/manager at your company?

Do you have authorization to represent your company on ACEA matters?

How did you hear about the ACEA?

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