• 1 NW OOIDA Drive, Grain Valley, MO 64029

  • Identity Theft Enrollment

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    MEMBER INFORMATION

    Mailing Address*
    Date of Birth*

    SELECT YOUR PROTECTION PLAN

    Select Your Plan:*

    FORM AGREEMENT & SUBMISSION

    Agreement: I am agreeing to purchase the Identity Resolution Services as selected electronically. I understand that a Welcome enrollment kit will be sent to me. I, also, acknowledge that the services are non-transferable and non-assignable and that services are automatically renewed unless cancelled in writing 10 days prior to service renewal date. I can withdraw my electronic consent within 10 days by sending a written request to (OOIDA, Attn: Life & Health Benefits Department, 1 NW OOIDA Drive, Grain Valley, MO 64029). However in the event I withdraw my electronic consent I understand that this agreement to provide services will be cancelled and I am not entitled to utilize the services referenced.
    YOU MUST SELECT THE CHECKBOXES BELOW AND SIGN:*

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