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SELF PAY 12-2095 ONLINE ENROLLMENT

Monthly Payment Plan

By submitting this application I confirm that I am legally residing in the United States and agree to the below Authorization of Payment, the membership fees selected below, and the terms of the selected membership plan.​

Please select your plan(s):
Available supplements with Legal Plan purchase:
Choose the method you prefer for monthly premiums
I authorize Legalshield to make direct payment by charge/draft of my checking/savings/credit card acct from the financial institution listed below. Authorization in effect until terminated in writing.

When you provide a bank draft as payment, you authorize LegalShield to execute an electronic fund transfer from your account.  Funds may be withdrawn from your account as soon as the same day payment is received. Your account will be drafted for the same amount each month on or about the effective date of your membership.  You waive your right to notification of continued payment, when applicable by law.

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By submitting this form, I acknowledge that the LegalShield Legal Plan and ID Shield benefits were made available and explained to me completely. I have seen the brochure/factsheet and/or video listing specific benefit and benefit limitations of these plans. 

Thanks for submitting!

Self Pay Option 12-1895: Price Quote
Self Pay Option 12-1895: Text
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