Pay My Bill — Texas Legal

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I authorize Texas Legal to charge my credit card the amount listed above:

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Credit Card Customers Please Complete Credit Card Information on this Form: I hereby authorize Texas Legal to charge the credit card below for a one‐time payment or for an annual recurring or monthly recurring 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.

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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.

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