First, we need to need some basic information from you.

Your updates may take up to seven (7) business days to complete. Changes received between the 1st and the 25th of each month are effective on the 1st of the following month. Please note that changes received between the 26th and 31st of the month are effective on the 1st of the month after. (For example, received on March 26th, effective May 1st).

If you wish to add more than four dependents, please contact us directly at 1-800-252-9346.

If you wish to remove more than four dependents, please contact us at 1-800-252-9346.

NOTICE: Returned Bank Drafts/Checks/Credit Card Payments Incur a $25 Fee.

Credit Card Customers Please Complete Credit Card Information on this Form: I hereby authorize Texas Legal to charge the credit card above for a one‐time payment or monthly payment of my premium or due fees, depending on my selection. I certify that I am the authorized holder and signer or have the consent of the authorized holder and signer of the credit card referenced above and that all information above is complete and accurate. I understand that this information will be securely maintained.

Independent Policy: I understand that Texas Legal Protection Plan, Inc. d/b/a Texas Legal ("Texas Legal") sets forth the terms on my membership, including any exclusions or limitations, and agree to be bound by the same. The Policy for Individual Benefits ("Independent Plan"), Schedule of Benefits, Declarations Page, and this application constitutes the entire agreement between the company and the member with respect to the membership, and there are no agreements, understandings, warranties or representations other than as set forth herein and in the those documents. Please honor payment option listed above or below on my account by Texas Legal to its own order.

Group Policy: I understand that Texas Legal Protection Plan, Inc. d/b/a Texas Legal ("Texas Legal") sets forth the terms on my membership, including any exclusions or limitations, and agree to be bound by the same. The Certificate of Coverage, together with the Master Policy, Schedule of Benefits, Declarations Page, endorsements and this application constitutes the entire agreement between the company and the member with respect to the membership, and there are no agreements, understandings, warranties or representations other than as set forth herein and in the those documents. Please honor payment option listed above or below on my account by Texas Legal to its own order.

Electronic signature: I agree that typing my name below constitutes my signature.