Pre-Paid Legal Services Plan from Wasserman & Miller

Yes, I want to begin receiving professional legal
protection with the W&M Legal Services Plan.

If paying by credit card, fill in this form and Fax it to (818) 895-0675

If paying by check, mail it together with your check to:
Wasserman & Miller Attorneys, 16380 Roscoe Blvd. Van Nuys, CA 91406

Name
E-Mail Address
Business Name
Address
City
State
Zip
Phone (day)
Phone (eve)

I prefer to pay the $325 per year:
By enclosed check payable to Wasserman & Miller Attorneys.
By credit card

MasterCard Visa Discover

Name on Card
Credit Card Number
Exp Date
 Month/Year
CVV2*
Exact Billing Address
City
State
Zip

Signature: