ACE New Member Application
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Thank you for your interest in the Association for Claims Exchange. In order for us to understand your role with ACE, we need you to complete the following information and return it as soon as possible to the ACE Manager. If you don't have a forms capable browser, send E-mail to ace@claims-exchange.org.

The ACE FAX number is 416-596-9532.

First Name*:         
Last Name:         
Title:                    
Address:             

Phone Number*:   
Fax Number:       
E-mail Address:  

Areas of Interest
Check all applicable:

Dental claims processing
Pharmacy claims processing
Other.
     Please Specify:

Nature of your Business
Please describe the nature of your business as it applies to ACE.


Representative
Please identify the member of your company who will be your representative at Association meetings and who can speak on your behalf.