Notification of Changes for Business Entity
General Information
Business Entity Name:	FIRST CHOICE AGENTS ALLIANCE, LLC
Incorporation / Formation Date:
FEIN:	47-3685294
Ohio License Number:	1070082
NPN:	17605617
DBA / Trade Name:
State of Domicile:	NC
County:	IREDELL
Business Address
Address 1:	135 GASOLINE ALLEY
Address 2:
City:	MOORESVILLE
State:	NC
Zip:	28117
Phone:	(888) 895-2115
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 5390
Address 2:
City:	MOORESVILLE
State:	NC
Zip:	28117
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	FIRST CHOICE INSURANCE BROKERS
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	ROB GRIFFIN
Title:	LISTING AGENT
Phone Number:	(888) 895-2115
Email Address:	ROB.GRIFFIN13@GMAIL.COM