GET COVERED WITH OUR PROACTIVE EMERGENCY SECURITY BENEFIT SOLUTIONS
Please fill out the following form to get your membership started. Please follow these instructions carefully, submit the form and look for an email requesting your electronic signature within the hour. If you don't get an email from us call 210-204-3310.
Agents Name: enter Rudy Cortez as your agent or the person who referred you.
Name Of Company: enter the name of the company you work for or enter "Household" if not working.
Date of Birth: enter in this format: 1-15-1980. Enter as DOB: 1-15-1980 in last message box below.
Enrollment Date/Time: enter 5-25-15 3:45 pm cst - month, day, year, am/pm and time zone (pst = pacific, mst = mountain, cst = central, est = eastern, ect...)
Temporary id#: enter your full social security number (without the dashes is ok): xxx-xx-xxxx or social insurance number: xxx-xxx-xxx.....once payment is confirmed for total amount entered, you will receive a membership id# in an email from us.
Type: enter MCA Security, Security Plus, Total Security or SBCA Green $42.90 or SBCA Platinum $110 Plan
Plan: pick a plan. ex. $9.95, $14.95, $19.95, $42.90 or $110 plan
Monthly Payment: enter the amount of the plan you selected; $9.95, $14.95, $19.95, $42.90 or $110
Total Amount: your monthly plan times 2 [ ex. $39.90 1st & last (if your selected plan is $19.95 x 2 this is your 1st & last month)], $19.90 1st & last for the $9.95 plan, $29.90 for the14.95 plan.
Credit Card: enter full card number
Expiration date: enter 10-1-2017 (month, day and year) for an expiration date of 10/17. in last message box below.