Enrollment

APPLICANT INFORMATION

Enrollment

Please fill out the following to start enrollment.

Product Selection:

Protection Plan - $8.95 per member per month

Complimentary Legal Consultation and Discounted Attorney Fees
Free Legal Forms and Resource Center
ID Theft Resolution
Roadside Assistance

Everyday Savings Plan - $7.95 per member per month

Discounts on Dining, Shopping, Professional Services and More
Grocery Coupons
Hotel and Lodging Discounts
Gym Membership Savings - Active&Fit Direct^TM Self-Pay Fitness Benefit
Vehicle Service Savings

Lifestyle and Protection Plan - $10.95 per member per month

Complimentary Legal Consultation and Discounted Attorney Fees
Free Legal Forms and Resource Center
ID Theft Resolution
Roadside Assistance
Discounts on Dining, Shopping, Professional Services and More
Grocery Coupons
Hotel and Lodging Discounts
Gym Membership Savings - Active&Fit Direct^TM Self-Pay Fitness Benefit
Vehicle Service Savings
Pet Assure Veterinarian Discounts
Pet Prescription Savings

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Gender:

Date of Birth:

Phone Number:

Email Address:

I have read and accept the Disclosures below.

SSP_Enrollment_0120

These benefits are NOT Insurance. You may cancel at any time by emailing info-abs@member-questions.com or calling 1-888-356-1787. If you cancel within 30 days of your effective date, you will receive a full refund of your membership fees.