Everyone: Please read

Important message; Your application will be forwarded electronically,

over a secure network for you security and privacy, to the home office of

Foster Parents Legal Solutions for processing. You will then receive, via email, your temporary membership card and instructions as to how to utilize your membership. Please let us know if you have an immediate need to talk to your Provider Law Firm. (Until your application is processed you are entitled to talk to your attorney if you have a need during the time that it takes to set up your access with your Provider Law Firm).

You will, in approximately four weeks, receive your membership kit from the underwriter, Pre Paid Legal Services, Inc. In the meantime if you have any questions please feel free to pick up the telephone and call your State Administrators office at 1-877-FPA-CHILD, we are here to serve YOU.

NOTE: If for any reason you are not able to fill out our application on line;

1. Print the application and fill it out. Select the method of payment

2. If you select a method other than credit card please submit a check with the application made payable to FPA Group Legal Services Trust

3. (If you need assistance see instructions under Monthly or Annual Bank Draft)

Then mail your application to:

Foster Parents Legal Solutions, PO Box 175 Yarnell, AZ. 85362

NOTE: If you choose to print the application fill it out and mail it to us, this will add some time it takes to process your application.

If you still have questions please call, e-mail, or fax us at

Phone 1-928-427-0088

Fax 1-928-427-0421

E-mail fplegalsolutions@gmail.com

Terms; Primary Member is the person whose social security number is used on the application.

Top Part of APPLICATION

member information

Left column

Today's Date Month, day, year. This is the date that your policy

will be in effect and this will also be the date that your account

will be charged, if you select bank draft method of payment.

Social Security Number . The primary members social security number.

Name. Primary member who's social security appears above.

Mailing address . This is the address that your membership kit will be sent to and all other correspondence with the underwriter.

Member's Date of birth. The primary member's birth date

Spouse. It is up to the primary member whether this information is to be included. If you choose not to list your spouse for any reason they will not be included in the coverage.

Work Phone Primary member's work phone and

Home phone number.

e-mail address

Email Address; Primary member, if this is a work associated email address please add (wk) at the end.

member information

Right column

PLEASE READ THIS NOTICE

NOTE only requirement to purchase this legal plan is;

You must be a member of a Foster Parent Association.

By signing this application, I represent that I am a member in good standing of a local, State, or the National Foster Parent Association.

NOTE: If you answered NO on our application you cannot continue until you join a Foster Parent Association.

If you are not yet a member of an association , please click on the link to National Foster Parents Association

This will take you to their web site and an application to either your state or the National Foster Parent Association.

Dependents: Your own children and this will include your foster children. If you have a foster child leave your foster care home notify the underwriter immediately and replace the child's name with the new foster child, otherwise the new child will not be covered on this Legal Plan.

Employer: Primary member, if you are a full time foster parent not employed outside of the home just put full time foster parent , on this line. For address of employer below put N/A

Address of your employer ; The address of your work Location.

Bottom Part of APPLICATION

Payment Information

1

Method of Payment selected

Monthly or Annual Bank Draft

Please read the Authorization statement

Left Column

Name of your Bank (or Financial Institution)

i.e.: Bank of America

Bank Address Mailing address of your bank.

City, State and Zip code of your bank.

Center Column

Account Number This is the last nine or ten digits on the bottom of your check.

Institution Transit Number This is the first nine or ten digits on the bottom of your check.

Signature of Account Holder X Primary member's checking or savings account.

Check in the appropriate boxes

Checking Account

Savings Account

(You will have to identify which type of account you wish to draft)

Right Column

Box

Fill in the appropriate amount for annual or monthly payment.

The one time application fee amount will be waved if you sign up from the web site.

2

Method of payment selected

Monthly or Annual Payment by Credit Card .

Your account will be charged on or about the 15th or 25th of each month.

Left Column

Card Number The number on the card just as it appears.

Card Holder's Signature The signature has to be as the name appears on the card

Right Column

Expiration date The month, day, and year of the cards expiration.

Type of Card Select either one Master Card or Visa.

3

Method of Payment Selected

Annual Direct Billing. If you select this method of payment you are authorizing a DEBIT to your bank account or your credit card for one year's payments (the total of twelve monthly payments) and you will be billed annually there after.

4

Method of Payment Selected.

This method of payment is available to Agencies on line. However, in order to process the applications on line Your Foster Parents will need to have a code number to access your group account on line. Please call our toll free number and speak to one of our State Administrators. Or we would be happy to make arrangements for a formal presentation and sign up at your agency. The State Administrator in the state that you reside in will contact you as soon as possible.