Notification of Changes for Business Entity
General Information
Business Entity Name:	IPA DIRECT LLC
Incorporation / Formation Date:
FEIN:	46-2506388
Ohio License Number:	1050881
NPN:	17016902
DBA / Trade Name:
State of Domicile:	FL
County:	SEMINOLE COUNTY
Business Address
Address 1:	1000 PRIMERA BLVD #1130
Address 2:
City:	LAKE MARY
State:	FL
Zip:	32746
Phone:	6028616035
Fax:
Business Web Site Address:
Business Email Address:	KELLY.MANUEL@IHCGROUP.COM
Mailing Address
Address 1:	5450 E HIGH STREET STE. 300
Address 2:
City:	PHOENIX
State:	AZ
Zip:	85054
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
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:	KELLY MANUEL
Title:	COMPLIANCE SPECIALIST
Phone Number:	6028616035
Email Address:	KELLY.MANUEL@IHCGROUP.COM