Civil & Criminal - protection for only $91.88* (Annually)

* = Includes annual non-refundable $5.00 Membership Fee

COVERAGE INCLUDES:

• CIVIL - DUTY RELATED

• CRIMINAL - DUTY RELATED

• COVERAGE PAID IN FULL WHEN USING A PLAN ATTORNEY

• NO DEDUCTIBLES

• $5,000 24 HOUR ACCIDENTAL & DISMEMBERMENT

• HR 218 COVERAGE - $5,000 CRIMINAL & $10,000 CIVIL

To enroll, complete and submit the signup and payment information below
 

IF YOU ARE INTERESTED IN MORE INFORMATION ON PROFESSIONAL LIABILITY FOR CONSTABLES, PLEASE CLICK HERE.

IF YOU PURCHASE A PROFESSIONAL LIABILITY POLICY, THIS WILL COVER YOU FOR CIVIL LIABILITY AND YOU CAN ADD CRIMINAL LEGAL DEFENSE ONLY FOR $53.00 ANNUALLY.

SIGNUP FORM

Fill out the form below and then click the "Submit" button at the bottom of this form.
 

CIVIL & CRIMINAL PROTECTION for only $91.88* (Annually)

 * = Includes annual non-refundable $5.00 Membership Fee

First Name:    Last Name:

Phone #:

Address:

City: State:   Zip:

Date of Birth:

Social Security #: (Last 4 digits):       
 
E-Mail Address:  

How did you hear about us: Referral Search Engine Co-worker Newsletter Marketing Material Group Presentation Other

I would like to receive future invoices electronically.

I hereby apply for enrollment in the PLEA Legal Defense Fund and Participation in the PLEA Trust.  I agree to abide by all terms and conditions thereof.  I understand that no coverage is in effect until this application is approved by the Plan Administrator.  To my knowledge, I am not presently named in any suits, action or proceeding nor under investigation for a duty-related incident, except for the following for which there would be no coverage under Plan:

In order to receive the free Accidental Death & Dismemberment Coverage you must complete the form below.  If you did not wish to receive this free coverage, please check the box below and skip to the payment section.

I would like to opt out of the free $5,000 Accidental Death & Dismemberment Coverage.  I have indicated this option by checking this box and therefore I may skip filling out the Beneficiary information below and proceed to the payment section.

Beneficiary Name:

Beneficiary Address:

Beneficiary City: Beneficiary State: Beneficiary Zip:

Relationship:

Signature:   Date:

PAYMENT SECTION
 

We accept the following ways to pay: Visa, MasterCard or Discover.

Credit Card Information:

Charge the amount of $91.88 to my:  Visa   MasterCard  Discover

Name On Card: 

Card Number: 

Expiration Date:    /    
                           Month   Year

CVV2# :   what is this?

I would like this to be a:  One Time Payment Recurring Payment

                               
Signature:   
By typing my name above, in the Signature field, I am signing my name for you to charge my credit card the amount shown above.  I am bound by all laws regarding electronic signatures.

This brochure contains only illustrative information about our Legal Defense Protection and is not a contract.  Refer to the Summary Plan Description for complete description of coverage, limitations and exclusions.

CARDMEMBER ACKNOWLEDGES RECEIPT OF SERVICES AND AGREES TO PERFORM THE OBLIGATIONS SET FORTH BY THE CARDMEMBER'S AGREEMENT WITH THE ISSUER.

Note: you can charge up to to the amount shown on the enrollment form.  If you choose a recurring payment the amount will be charged on a regular basis on or about the due date.  It is not necessary for the Company to notify me when this is done.  Any requirement for giving notice due shall be waived as long as this payment plan is in effect.  No payment or portion thereof shall be deemed to have been paid unless and until the Company received actual payment at its home office.  This payment shall in no way alter or amend the provisions of the policy and no one other than the policyholder and his assignees will have any interest in the policy. This payment plan shall continue in effect until terminated by the Company or by me.  In addition the Company may terminate this payment plan immediately if any charge is dishonored upon presentation.

 YOU MUST PRESS THE "SUBMIT" BUTTON BELOW TO COMPLETE YOUR PAYMENT.