Florida Pre-paid Legal Services

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Step 1... Complete the enrollment form 1) Email: 2) First Name: 3) Middle Initial: 4) Last Name: 5) Date Of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 [mm/dd/yyyy] 6) Address: 7) City: 8) Zip Code: 9) Home Phone: 10) Work Phone: 11) Spouse First Name: 12) Spouse Middle Initial: 13) Spouse Last Name: 14) Dependent 1 Full Name: 17) Dependent 2 Full Name: 20) Dependent 3 Full Name: 23) Dependent 4 Full Name:

Step 2...Once you click Submit, Our Client Service associate with contact you shortly to complete the registration. Your membership package will arrive in 3 weeks from the date your credit card payment is approved, but you can start using your plan immediately. Mailing Information: 10800 Biscayne Blvd. #580 Miami, FL 33161

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