Notification of Changes for Business Entity
General Information
Business Entity Name:	INSERVICES, LLC
Incorporation / Formation Date:
FEIN:	731396387
Ohio License Number:	41557
NPN:	1912604
DBA / Trade Name:	DILLINGHAM INSURANCE
State of Domicile:	OK
County:	GARFIELD
Business Address
Address 1:	2402 W. WILLOW
Address 2:
City:	ENID
State:	OK
Zip:	73703
Phone:	5802332000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 1669
Address 2:
City:	ENID
State:	OK
Zip:	73702
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	INSERVICES, INC.
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)	NO
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?	NO
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:	JOHN EDWARD DILLINGHAM
Title:	OFFICER
Phone Number:	5802332000
Email Address:	JOHN.E.DILLINGHAM@DILLINGHAMINSURANCE.COM