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  • TSLA: Texas Surplus Lines Association, Inc. TSLA: Texas Surplus Lines Association, Inc.
    TSLA
    TSLA
    TSLA
    Contact Information:
    TSLA
    Phone: 512.343.9058
    TSLA
    Thank you for visiting TSLA, a non-profit, trade association of excess and surplus lines brokerage and underwriting professionals. If you would like more information about our association and membership benefits, please contact us at your convenience:
    TSLA
    phone:
    512.343.9058
    TSLA
    TSLA
    TSLA
    fax:
    512.343.2896
    TSLA
    TSLA
    TSLA
    address:
    Great Hills Corporate Center
    9020-I Capital of TX Hwy N., Suite 370
    Austin, TX 78759
    TSLA
    TSLA
    TSLA
    email:
    jptsla@tsla.org
    TSLA
    information:
    Info Request Form
    TSLA
    TSLA
    TSLA
    TSLA

    TSLA Dues Renewal Statement

    2017 Membership Renewal

    TSLA

    If you wish to pay the membership dues for your firm by check or credit card, please complete the information below:


    This Online Application is on a Secure
    Server. Click on the seal on the left
    for more information on the
    certificate's authentication.

    Please note: Only one person from each firm should complete the 2017 Dues Renewal form.

    General Information
    This section must be completed in order to register online
    Business Name:  
    Contact Name:  
    Phone Number:  
    Email:  

    Membership Information
    Please fill in or select each line that applies to your firm.
      Voting Member: TSLA Membership Renewal
     (based on # of employees in all of your offices,
      including branch offices)
    TSLA
    1-10 employees - $1000
    11-30 employees - $1400
    31-50 employees - $1700
    51-75 employees - $2100
    76+ employees - $2500
        Total # of Employees:
    TSLA Membership Renewal
     $
      Provisional Member: TSLA Membership Renewal
     ($1000 flat fee)
    TSLA Membership Renewal
     $
      Affiliate Member: TSLA Membership Renewal
     ($1000 flat fee)
    TSLA Membership Renewal
     $
      Associate Member: TSLA Membership Renewal
     ($800 flat fee)
    TSLA Membership Renewal
     $
      Late fee: TSLA Membership Renewal
     ($50 if sent after 60 days)
    TSLA Membership Renewal
     $
      TSLA Membership Renewal
    Total Due: 
    TSLA Membership Renewal
     $

    Payment Information
    Type of Payment: Credit Card   Check  
    If CREDIT CARD, please complete section below
    A receipt will be emailed to this address: 
    Credit Card Type:  
    Credit Card #:  
    CVV / CVC Code:   What's This?
    Expiration Date: (mmyy) 
    First Name:   Last Name:  
    Credit Card Billing Address:   
    Billing City:    State:   Zip:

    If paying by check, please remit to:
    TSLA
    Texas Surplus Lines Association (TSLA)
    9020-I Capital of Texas Hwy N. #370
    Austin, Texas 78759

    Balance is due thirty (30) days from receipt of this statement. All dues need to be paid by 12/31/16 to avoid the $50 late fee. All payments received after 12/31/2016 may result in firm not being listed in the 2017 Membership Roster & Product Guide.

    (Purple Book) Roster Listing
    Please be sure to check your roster listing at www.tsla.org and let Jean jptsla@tsla.org know if any changes/additions or deletions need to be made. Please note that the TDI will not refer anyone in our purple book who is not licensed. Thank you for your renewal. We appreciate your continued support!
    I've reviewed our current membership info on the TSLA web and found all to be in order.
    I've reviewed our current membership info on the TSLA web and have the following changes:
    TSLA

    Additional Comments
    Please enter any additional comments in regards to your Membership Renewal.

    TAX INFORMATION: Please note that dues are not deductible as charitable contributions for federal income tax purposes. Also, pursuant to the Revenue Reconciliation Act of 1993 fifty percent (50%) of your total dues for this year are a non-deductible lobbying expense and cannot be deducted as a business expense.


    Please press Submit below to send your Membership Renewal to TSLA. Please review your information for accuracy before submitting this form. TSLA is not responsible for any incorrect information entered into this form.

    You must check the box below in order to submit your registration:

     I agree to allow TSLA to bill my credit card (if applicable) and have reviewed all info I have provided for accuracy.
    TSLA
    Please use the Print Application button below to print
    a copy of your Membership Renewal before submitting
    TSLA
          and / or      

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