PERSONAL INFORMATION

EMPLOYMENT INFORMATION

PAYMENT

I hereby authorize the Professional Law Enforcement Association or Professional Law Enforcement, Inc. herein called PLEA to initiate credit entires and to initiate, if necessary, debt entires and adjustments for any credit entires in my error to the account indicated below and the financial institution named below, to debit and/or credit the same to such account.

This authority is to remain in full force and effect until PLEA has recieved a written notification from me of its termination in such time and in such manner as to afford PLEA and the financial institution named below reasonable opportunity to act on it. I further understand that a re-processing fee of $35.00 will be charged for each return item.

ADMINISTRATIVE

I affirm that I have read the legal defense policy and understand and agree to the contents and terms. I understand that I am responsible to contact the association if or when any of the above information changes to keep my contact information up to date. I agree to support the principles of PLEA and understand that any false information on my part will result in the immediate termination of my membership. I wish to have deducted the amount of $28.00 (Twenty-eight dollars) bi-weekly from the above account to be an active member of PLEA. I agree to receive emails from PLEA and understand that I can opt-out anytime by clicking the unsubscribe link in their emails.