Second Call Defense




Membership Application
1. Choose your Membership
Defender
($14.95 monthly/$179.00 annual)
($19.95 monthly/$239.00 annual)

Ultimate
($34.95 monthly/$399.00 annual)
($41.95 monthly/$479.00 annual)

Ultimate Plus
($44.95 monthly/$499.00 annual)
($53.95 monthly/$598.00 annual)

(*) Rates shown include all applicable premiums, taxes, and fees.

2. Choose your Payment Term
 *  

3. Confirm Your Information
Applicant Information
 
 


In an emergency, we may need to contact family members or friends about your situation.
Please list someone we may contact:

If you were referred by a Second Call Defense Recruiter, please provide Name and ID#

THE APPLICANT WARRANTS THAT THE STATEMENTS AND RESPONSES TO THE QUESTIONS ON THIS APPLICATION ARE TRUE AND COMPLETE. THE SUBMITTAL OF THIS APPLICATION DOES NOT BIND THE COMPANY TO OFFER NOR APPLICANT TO ACCEPT INSURANCE, BUT IT IS AGREED THAT THIS APPLICATION SHALL BE THE BASIS OF THE INSURANCE APPLIED FOR. ANY SUCH INSURANCE ISSUED BY THE COMPANY AND ACCEPTED BY THE APPLICANT MAY BE CANCELLED BY THE COMPANY FROM INCEPTION UPON DISCOVERY THAT THE INSURANCE WAS OBTAINED THROUGH ANY FRAUDULENT STATEMENT, OMISSION, OR CONCEALMENT OF ANY FACTS MATERIAL TO THE ACCEPTANCE BY THE COMPANY OF THE RISK OR HAZARD ASSUMED.

 *
Captcha image
Show another codeShow another code


v11.5