Last 4 of Social Security Number
Personal Information:
Choose One Plan:
Family:
Individual:
$8.95/mo
$15.95/mo
$24.90/mo
$18.95/mo
$30.90/mo
Select One Payment Option:
Payroll Deduction Authorization:
I hereby Authorize my employer listed above to deduct the selected plan price each month from my earnings for my LegalShield/IDShield Membership and to remit such amount directly to LegalShield.
Your Signature
Family Information:
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