Your Plan Order

Benefit Plan Order Form

Thank you for deciding to join our plan. Your membership information will be sent via USPS First Class Mail and should arrive within 10 business days. Remember, your complete satisfaction is very important to us and all of our plans are backed by our iron-clad money back guarantee. Please refer to the membership materials for important Customer Service numbers and other important membership details.

Complete Your Order

Please complete this order form and click on the 'Submit' button to confirm your subscription. Your credit card will be charged the amount indicated on the form.

Your order will be reviewed for accuracy and we may contact you to confirm your choices and for security purposes.

Your membership booklet will contain important Customer Service contact information for any changes or cancellations.

Plan Summary

Your plan contains the items listed below. You can click on any of the services to learn more about their specific features:

LifeLock - Individual

Legal Care Direct

Roadside Assist

Locate Providers

Plan Costs

Your credit card will be charged the following:

monthly fee of $19.95
one-time registration fee of $4.95

Do you have a Referral Code?

Contact Information

Your first and last name:

Your email address (for your order confirmation):

Your phone number:

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Billing Information

Please provide us with your billing address. Please make sure to provide accurate information in order to avoid processing delays.

Your street address:

Your city, state and Zip code:

Shipping Information

Please provide us with the shipping address for this order. If your billing and shipping addresses are the same, please check the box below.

Same as Billing Information

First and last name:

Shipping street address:

Shipping city, state and Zip code:

Your Dependents

Dependent information is not required for the purchase of discount benefit plans. All family members can receive discounts using the card issued in the main member’s name. If you would like to receive additional cards reflecting the name of your dependents, please add them to the list below. Each dependent card requested will result in a one-time printing charge of $2.50 in addition to the price of your benefit purchase today. All recurring payments will be processed for the price of benefits only (when applicable).

Billing Information

Your Credit Card Number:

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We accept all major credit cards

Your Credit Card Expiration Date:

Your credit card CV Number (what is this?):

BQKEYLIFE-W

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