Credit Union Prepaid Legal Services Plan Membership Contract

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Personal Information

Dependents: Covered only if claimable on income tax purposes

I apply for membership in the Credit Union Prepaid Legal Services Plan and understand that my annual fee of $144.00 is payable with my application.
I have received and read a copy of the Regulations of the Credit Union Prepaid Legal Services Plan which is part of this contract and upon which terms I will abide in order to receive my legal benefits.

For Credit Union Prepaid Legal Services Plan

Your legal services will be available at the law offices of:

Staples, Ellis + Associates, P.A.
Attorneys at Law
201 N. Palafox Street
2nd Floor
Pensacola, FL 32502
If you have any questions, please contact the law office at 850-432-4143

Automatic Renewal

I want to elect to automatically renew my membership each year for $144.00 until I notify Staples, Ellis + Associates, P.A. that I wish to discontinue my membership.

Authorization Card

I do hereby authorize the Credit Union to forward the sum of $144.00 to Staples, Ellis + Associates, P.A. for payment of the Prepaid Legal Service Plan each 12 months until notified to discontinue.

I understand a notice of renewal will be sent to me by the law firm each year.

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