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JOIN NOW AND BECOME A MEMBER TODAY!

A Legacy Assurance membership gives your loved ones peace of mind. On the day you join this special program, the prices for caskets, urns, monuments, and vaults are locked-in… FOREVER. A great benefit for everyone. Living benefits are included, too, so you can save thousands on discounted diabetic supplies and hearing supplies.

Personal Information

Email Address:

First Name:

Last Name:

Gender:

Social Security Number:

Date of Birth:

Phone Number:

Membership Kit Language:

Address Information

Address Line 1:

City:

State:

Zip Code:

Billing Information

Payor Name:

Which day should we bill you every month?

What is your preferred payment method?

Banking Information

What date would you prefer to make the first payment?

What is the name of your financial institution?

What city is your financial institution located in?

What state is your financial institution located in?

What is your routing number?

What is your account number?

I agree to pay a monthly fee of $4.00 for these services. I agree to Legacy Assurance's Terms & Conditions. I acknowledge that this information is being submitted securely. My information will not be shared with third parties.