Name* First Last PhoneEmail* Please Select One Of The Following*I am a CARRIER wanting more information.I am a DRIVER signing up for membership.My DOT number:I Work For:*Spouse's Name First Last My Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CDL Number*CDL State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLast 4 Digits of SSN*Date of Birth* Date Format: MM slash DD slash YYYY Please Charge Me$33.53 / Monthly$92.85 / Quarterly$368.83 / AnnuallyDesired Start Date Date Format: MM slash DD slash YYYY Type Of CardVisaMastercardAmerican ExpressCard NumberCard NumberCard Billing Zip*Expiration MonthExpiration YearSecurity Code (MC/Visa)*Security Code (Amex)*Acknowledgement* I am electing to participate in CDL Legal and authorize my company to deduct from my payroll/settlement the member fees as set above to be paid to CDL Legal. CDL Legal may share with participating carrier information about member claims as part of company safety reviews. Coverage goes into effect after the first payroll/settlement deduction by your company. Plan fees may change with 30 days written notice from CDL Legal. By checking the box, I am agreeing to the CDL Legal terms and conditions. Please refer to our website. I understand that I may cancel my plan benefits at any time. CONTACT US FollowFollowFollow Terms and Conditions, Copyright 2020 Share this:TwitterFacebookMorePrintLinkedInPinterestEmail