Membership Application Form

International Credit Executives Group
Membership Application Form

Please fill out this form to join the International Credit Executives Group. 2011 Membership dues for the first year are $600 which is discounted $100 and includes membership services through ICE and the Business Credit Management Association - Wisconsin (WCA). Membership benefits in ICE and the Association are extended to all individuals at your business location. (Branch locations will require an additional ICE Group membership, $475). If you require a copy, print the form before clicking the Submit button. If you prefer, you can mail the form to: ICE, c/o WCA, PO Box 510157, New Berlin WI 53151-0157 or fax to 262-827-2899. Please call Dianna Rowinski with any questions at 262-827-2880 X225.

Company:

Address:    City:    State:    Zip:
Phone:         Fax:
Email:

Main Contact Name: Title:
Check all that apply: CBA CBF CCE CCP CICP CICECPC
Please list additional contacts (include title and email addresses):

Clicking here acknowledges that you agree to abide by the ICE Group's Rules & Procedures.

Payment Method: Invoice my company Check Enclosed (or in the mail) Credit Card (call 262/827-2880 or fill out information below)

Credit Card Payments Only
Please note that this is not a secure site. You may submit information via this form, however ICE/WCA assumes no liability. You may also call the WCA office at 262-827-2880 or fill out the form, print it, and fax to 262-827-2899.

Type of card: VISA MASTERCARD DISCOVER AMERICAN EXPRESS
Name on card:
Billing Address:     City:   State:    Zip Code:
Card Number:        Expiration Date:

Checking here indicates that you authorize WCA to process your credit card for payment of membership:

By applying for ICE Group membership, member company and its representatives agree to adhere to the Rules & Procedures of the International Credit Executives Group of Wisconsin.