Legal Plan Quote




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Family Legal Plan Enrollment

Thank you for your decision to join Legal Club of America®. Please take a moment to fully read and complete the information below. If you decide to change any information after entering your data, highlight and re-enter the data, or click the "Clear Form" button at the bottom to reset the entire form.

* - These fields are required.

* First Name:
* Last Name:
* SSN:
* Date of Birth:	mm: dd: yyyy:
* Street Address:
Street Address:
* City:
* State:
* Zip Code:
* Telephone:
* E-mail:

Spousal Information

Spouse's Name:
Social Security #:

Children Information

Child 1 Name:		DOB: mm: dd: yyyy:
Child 2 Name:		DOB: mm: dd: yyyy:
Child 3 Name:		DOB: mm: dd: yyyy:

Payment Information
Visa Master Card Discover American Express	* Card Number:
Visa Master Card Discover American Express	* Card Expiration:	mm: yyyy:
- or -
ACH	* Bank Name:
	* Account #:
	* RoutingNumber:

Payment Frequency

   Annually ($144.00)
   Three Consecutive Monthly Payments ($48.00)
   Monthly ($12.00)

Yes, I want to enroll in the Legal Club of America® Family Legal Plan. The annual membership fee is only $144.00 per year for my family. I will have access to all the services and benefits outlined on the web site page, subject to the terms and conditions in the Planmember Guidebook. Upon enrollment I will have 30 days to cancel my membership. The plan is not party to any confidential relationship which I may establish with any participating attorney. I understand that this plan is not insurance coverage. I understand that costs and filing fees are additional.

By clicking "submit" you are representing and acknowledging that you are authorized to use the credit card listed above.

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Legal Club of America Corporation
Corporate Headquarters
8551 W. Sunrise Blvd.
Suite 105
Sunrise, Florida 33322
(954) 377-0222