PPL LEGAL CARE OF CANADA CORPORATION

A S U B S I D I A R Y O F P R E - P A I D L E G A L S E R V I C E S , I N C . payment information

[Available through IVR at (800) 699-9004]Applicantsassigned Assoc. #

If operating under a company name, print it here:

personal information

$249.00

Associate Agreement Entry Fee 65.00

Applicable GST/HST/PST $

TOTAL to PPLSI:

Paid By:

.$

.$

.$

.$

.$

Money order Cheque Credit Card

Your credit card #

Expiration Date /

Email Address

Mr. Mrs. Miss. Ms. Dr.

Insurance No.Applicant’s Social

Spouse Last Name(Use for Corporations)

(First Name)

(IF Applicant is knownby another name other than the one above, Please PRINT HERE)

(First Name)

Applicant’s LastName

Middle Initial

Middle Initial

(Your privacy is a priority with us! PPLSI will not sell your email address or personal information of any kind to third party vendors.)

Sponsoring Associate (Associate under whom the new Associate is being placed or is signing under) I certify that I understand I am responsible for working with the new Associate listed on this Associate Agreement.

Fill in either the Individual SSN OR the Federal Tax I.D. No.. for Corporations. • Income will be reported to the number you list below. The SSN must match the name listed.

Placing Associate: By signing this form, I certify that I understand I personally recruited this new Associate and placed him or her in my organization under the Sponsor listed.

Use the same account used for the Associate Agreement Entry Fee

Receive Commissions by Direct Deposit! CHOOSE ONE: Daily Weekly Monthly (Subject to minimum accrual and other criteria established by the company)

In CANADA: We need your account information for direct deposit.CHOOSE ONE: Cheque Savings OR

CHOOSE ONE of the following methods by which you wish to receive commissions for memberships written under this Associate Agreement: 1-Year Earnings Plan OR 3-Year Earnings Plan

Signature of Applicant X

White Copy: Home O�ce -- Ada, OK Yellow Copy: Sponsoring Associate Pink Copy: New Associate

Please print in ALL CAPITAL letters. Use ONLY BLUE or BLACK INK. FAILURE TO PRINT LEGIBLY and WITHIN THE CONSTRAINTS OF THE RED BOXES can cause DELAYS IN PROCESSING YOUR APPLICATION.

Placing Assoc. #Sponsoring Assoc. #

@

NOTE: PLEASE PROVIDE COMPLETE INFORMATION WITHOUT ABBREVIATIONS.

To be paid by direct deposit, you must include a voided cheque or deposit slip from the account into which the commissions are to be deposited Unless you are paying your Associate Agreement Entry Fee by cheque from the same account into which you want your commissions directly deposited. If you do not provide information for direct deposit and cheque one of the options above, you will be paid commissions by cheque on a monthly basis subject to minimum accrual and other criteria established by the company.

The advance amount you receive is the same under both options, but your earnings and chargeback amounts will differ between the two. For details on compensation, please see a complete Pre-Paid Legal Associate Compensation Plan. If you do not select one of the compensation methods listed, you will automatically be paid on the 1-Year Earnings Plan for memberships written under this Agreement.

Member Advantage Services (MAS) provides follow-up phone calls, emails and letters to your members encouraging use of their memberships to increase retention potential. By checking this box, I affirm I want to sign up all memberships written for MAS and agree to the following terms: • Cost is $6.95 per member. • All charges from MAS will be deducted from PPL commissions.

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Associate Name & Phone# Associate Name & Phone#

INSTRUCTIONS:

A B A BCorrect Incorrect

Correct Incorrect

City

Province

City

Postal Code

Province

Home Phone

Business Phone

Fax #

DOB / /

Ext.

Apt. # Ste. #

Apt. # Ste. #

Mailing Address

Shipping Address(No P.O. Boxes)

MA

ILIN

G A

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SHIP

PIN

G A

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When you provide Pre-Paid Legal Services, Inc. with a cheque presented as payment, you authorize Pre-Paid Legal Services, Inc. to use the information from your cheque to make a one-time electronic fund transfer from your account or to process the payment as a cheque transaction. Funds may be withdrawn from your account as soon as the same day payment is received. For inquiries, please call: 580-436-7424.

GST Registration No.

Postal Code

In US: We need your account information for direct deposit.CHOOSE ONE: Cheque Savings OR Use the same account used for the Associate Agreement Entry Fee

• Registrations may not process if commission balance is negative. • There are no refunds or credits. • Written notice must be submitted to PPL to stop service. •It is up to the Associate to ensure correct account information and contact PPL as soon as possible with any updates.

Associate fees will not be refundable unless the Associate Agreement is terminated by the Associate within the first 30 days after the effective date, any marketing materials or supplies are returned in usable condition and the Associate has not sold any memberships or recruited any other Associates.

1. Have you ever been convicted of a felony for which a pardon has not been granted? 2. Has anyone who might write business under this Associate Agreement ever been convicted of a felony for which a pardon has not been granted?

3.Has any professional license (i.e. an insurance license) held by you in any state been suspended or revoked? 4.Has any professional license held by anyone who might write business under this Associate Agreement in any state been suspended or revoked?

Yes No

Yes No

Yes No Not Applicable

Applicant’s Pre-Paid Legal Membership #

Signature of Applicant X

Yes No Not Applicable

If you answered Yes on any of these questions, please send documents concerning the matter. Having a felony will not necessarily preclude your acceptance as an Associate.

The following questions MUST be answered, if applicable, or the application will be returned:

• By signing this form, I certify that I accept the placement of my Associate Agreement under the sponsoring Associate.• I have had explained to me the PPL Legal Care of Canada Corporation membership and compensa tion plan and understand the benefits of both. • I have read the Company policies and procedures on the reverse side of this form and been given a copy and agree to abide by them.• If paying by cheque, I agree that PPLSI may convert my cheque into an electronic debit to be drawn on my account for the face amount shown on the cheque I’ve provided.• I understand this agreement is subject to approval by a duly authorized officer/representative of PPL Legal Care of Canada Corporation.

Your Right to Privacy: By signing this application, I confirm that I have read and understand the Privacy Policy and Practices found on the reverse side of this application and understand that it applies to this application, any related agreements and arrangements, and any modification, extensions and renewals thereof. I consent to the collection, use and disclosure of my personal information as outlined in the Privacy Policy and Practices.

Welcome to Pre-Paid Legal!We trust you’ll take advantage of all the resources designed to help you every step of the way in your new business endeavor!

CFT Associate Quick Advance:With help from your sponsoring Associate, recruit three (3) new Associates, each with a membership and receive three (3) counters, OR sell five (5) unique memberships, all within 45 days, and you could advance to Associate!How Does the CFT Program Work?The purpose of the program is to encourage you to train your new Associates, ultimately making them, and you, more successful. They get the benefit of your experience, you earn an extra commission on their first three (3) members when they CFT qualify.

See compensation plan for details about the CFT program!

Get Connected!• Know your support team’s contact information and let them know if you have questions.• Get plugged into the many communication avenues Pre-Paid Legal has to offer. You’ll find out how in your Associate Introductory Kit you’ll receive soon. • Subscribe to eService and get your own prepaidlegal.com website, a subscription to The Connection, an Associate magazine and DVD published monthly, and more, for only $19.95 per month. PLUS - Get your �rst 30 days free!

Your Associate Introductory KitYou should receive your Intro Kit in the mail within 7-10 days. The kit includes everything you’ll need to get started,including:• Your Success Guide CD (a detailed guide to introduce you to your new business)• Startup supplies including brochures, applications, and compensation plans• Business card & letterhead ordering information• Many more sources of information that will give you the knowledge you need to get off to a fast start with your new business

PLUS! You’ll receive replenishments of applications and product brochures proportional to your sales.

Questions? We’re here to help! Call PPL Marketing Services at (580) 436-7424, 7am-7pm CT.

If any of the above change after your Associate Agreement is approved, you are required to notify PPLSI immediately.

Fast Start Entry Fee

CONFIDENTIAL

AA.PPL.05.07AA.CAN. 3.10

PPL LEGAL CARE OF CANADA CORPORATION

A S U B S I D I A R Y O F P R E - P A I D L E G A L S E R V I C E S , I N C . payment information

[Available through IVR at (800) 699-9004]Applicantsassigned Assoc. #

If operating under a company name, print it here:

personal information

$249.00

Associate Agreement Entry Fee 65.00

Applicable GST/HST/PST $

TOTAL to PPLSI:

Paid By:

.$

.$

.$

.$

.$

Money order Cheque Credit Card

Your credit card #

Expiration Date /

Email Address

Mr. Mrs. Miss. Ms. Dr.

Insurance No.Applicant’s Social

Spouse Last Name(Use for Corporations)

(First Name)

(IF Applicant is knownby another name other than the one above, Please PRINT HERE)

(First Name)

Applicant’s LastName

Middle Initial

Middle Initial

(Your privacy is a priority with us! PPLSI will not sell your email address or personal information of any kind to third party vendors.)

Sponsoring Associate (Associate under whom the new Associate is being placed or is signing under) I certify that I understand I am responsible for working with the new Associate listed on this Associate Agreement.

Fill in either the Individual SSN OR the Federal Tax I.D. No.. for Corporations. • Income will be reported to the number you list below. The SSN must match the name listed.

Placing Associate: By signing this form, I certify that I understand I personally recruited this new Associate and placed him or her in my organization under the Sponsor listed.

Use the same account used for the Associate Agreement Entry Fee

Receive Commissions by Direct Deposit! CHOOSE ONE: Daily Weekly Monthly (Subject to minimum accrual and other criteria established by the company)

In CANADA: We need your account information for direct deposit.CHOOSE ONE: Cheque Savings OR

CHOOSE ONE of the following methods by which you wish to receive commissions for memberships written under this Associate Agreement: 1-Year Earnings Plan OR 3-Year Earnings Plan

Signature of Applicant X

White Copy: Home O�ce -- Ada, OK Yellow Copy: Sponsoring Associate Pink Copy: New Associate

Please print in ALL CAPITAL letters. Use ONLY BLUE or BLACK INK. FAILURE TO PRINT LEGIBLY and WITHIN THE CONSTRAINTS OF THE RED BOXES can cause DELAYS IN PROCESSING YOUR APPLICATION.

Placing Assoc. #Sponsoring Assoc. #

@

NOTE: PLEASE PROVIDE COMPLETE INFORMATION WITHOUT ABBREVIATIONS.

To be paid by direct deposit, you must include a voided cheque or deposit slip from the account into which the commissions are to be deposited Unless you are paying your Associate Agreement Entry Fee by cheque from the same account into which you want your commissions directly deposited. If you do not provide information for direct deposit and cheque one of the options above, you will be paid commissions by cheque on a monthly basis subject to minimum accrual and other criteria established by the company.

The advance amount you receive is the same under both options, but your earnings and chargeback amounts will differ between the two. For details on compensation, please see a complete Pre-Paid Legal Associate Compensation Plan. If you do not select one of the compensation methods listed, you will automatically be paid on the 1-Year Earnings Plan for memberships written under this Agreement.

Member Advantage Services (MAS) provides follow-up phone calls, emails and letters to your members encouraging use of their memberships to increase retention potential. By checking this box, I affirm I want to sign up all memberships written for MAS and agree to the following terms: • Cost is $6.95 per member. • All charges from MAS will be deducted from PPL commissions.

The i

nfor

mat

ion y

ou pr

ovid

e on t

his a

pplic

atio

n is c

onsid

ered

non-

publ

ic in

form

atio

n, an

d Pre

-Pai

d Leg

al ta

kes c

are t

o pro

tect

your

info

rmat

ion.

/ /Todays Date

Amount to be charged:

Associate Name & Phone# Associate Name & Phone#

INSTRUCTIONS:

A B A BCorrect Incorrect

Correct Incorrect

City

Province

City

Postal Code

Province

Home Phone

Business Phone

Fax #

DOB / /

Ext.

Apt. # Ste. #

Apt. # Ste. #

Mailing Address

Shipping Address(No P.O. Boxes)

MA

ILIN

G A

DD

RESS

SHIP

PIN

G A

DD

RESS

(If D

i�er

ent f

rom

mai

ling)

When you provide Pre-Paid Legal Services, Inc. with a cheque presented as payment, you authorize Pre-Paid Legal Services, Inc. to use the information from your cheque to make a one-time electronic fund transfer from your account or to process the payment as a cheque transaction. Funds may be withdrawn from your account as soon as the same day payment is received. For inquiries, please call: 580-436-7424.

GST Registration No.

Postal Code

In US: We need your account information for direct deposit.CHOOSE ONE: Cheque Savings OR Use the same account used for the Associate Agreement Entry Fee

• Registrations may not process if commission balance is negative. • There are no refunds or credits. • Written notice must be submitted to PPL to stop service. •It is up to the Associate to ensure correct account information and contact PPL as soon as possible with any updates.

Associate fees will not be refundable unless the Associate Agreement is terminated by the Associate within the first 30 days after the effective date, any marketing materials or supplies are returned in usable condition and the Associate has not sold any memberships or recruited any other Associates.

1. Have you ever been convicted of a felony for which a pardon has not been granted? 2. Has anyone who might write business under this Associate Agreement ever been convicted of a felony for which a pardon has not been granted?

3.Has any professional license (i.e. an insurance license) held by you in any state been suspended or revoked? 4.Has any professional license held by anyone who might write business under this Associate Agreement in any state been suspended or revoked?

Yes No

Yes No

Yes No Not Applicable

Applicant’s Pre-Paid Legal Membership #

Signature of Applicant X

Yes No Not Applicable

If you answered Yes on any of these questions, please send documents concerning the matter. Having a felony will not necessarily preclude your acceptance as an Associate.

The following questions MUST be answered, if applicable, or the application will be returned:

• By signing this form, I certify that I accept the placement of my Associate Agreement under the sponsoring Associate.• I have had explained to me the PPL Legal Care of Canada Corporation membership and compensa tion plan and understand the benefits of both. • I have read the Company policies and procedures on the reverse side of this form and been given a copy and agree to abide by them.• If paying by cheque, I agree that PPLSI may convert my cheque into an electronic debit to be drawn on my account for the face amount shown on the cheque I’ve provided.• I understand this agreement is subject to approval by a duly authorized officer/representative of PPL Legal Care of Canada Corporation.

Your Right to Privacy: By signing this application, I confirm that I have read and understand the Privacy Policy and Practices found on the reverse side of this application and understand that it applies to this application, any related agreements and arrangements, and any modification, extensions and renewals thereof. I consent to the collection, use and disclosure of my personal information as outlined in the Privacy Policy and Practices.

Welcome to Pre-Paid Legal!We trust you’ll take advantage of all the resources designed to help you every step of the way in your new business endeavor!

CFT Associate Quick Advance:With help from your sponsoring Associate, recruit three (3) new Associates, each with a membership and receive three (3) counters, OR sell five (5) unique memberships, all within 45 days, and you could advance to Associate!How Does the CFT Program Work?The purpose of the program is to encourage you to train your new Associates, ultimately making them, and you, more successful. They get the benefit of your experience, you earn an extra commission on their first three (3) members when they CFT qualify.

See compensation plan for details about the CFT program!

Get Connected!• Know your support team’s contact information and let them know if you have questions.• Get plugged into the many communication avenues Pre-Paid Legal has to offer. You’ll find out how in your Associate Introductory Kit you’ll receive soon. • Subscribe to eService and get your own prepaidlegal.com website, a subscription to The Connection, an Associate magazine and DVD published monthly, and more, for only $19.95 per month. PLUS - Get your �rst 30 days free!

Your Associate Introductory KitYou should receive your Intro Kit in the mail within 7-10 days. The kit includes everything you’ll need to get started,including:• Your Success Guide CD (a detailed guide to introduce you to your new business)• Startup supplies including brochures, applications, and compensation plans• Business card & letterhead ordering information• Many more sources of information that will give you the knowledge you need to get off to a fast start with your new business

PLUS! You’ll receive replenishments of applications and product brochures proportional to your sales.

Questions? We’re here to help! Call PPL Marketing Services at (580) 436-7424, 7am-7pm CT.

If any of the above change after your Associate Agreement is approved, you are required to notify PPLSI immediately.

Fast Start Entry Fee

CONFIDENTIAL