CDL Legal / PAM / Confirm

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Name*
First Last
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Phone
Hidden
Email*
Address
Street Address City State ZIP Code
Spouse's Name
First Last
CDL Number*
CDL State*
Your Driver ID at PAM*
Last 4 Digits of SSN
Date of Birth
MM slash DD slash YYYY
P.A.M. Orientation Location*
- Tontitown, AR
- Laredo, TX
Please Select One Of The Following*
- I am a Company Driver electing for payroll deductions of $7.73/week
- I am a Truck Owner/Lease Operator electing for settlement deductions of 7.73/week
- I drive for a Truck Owner my payment information is below
Please Charge Me
- $33.50/month
Desired Start Date
MM slash DD slash YYYY
Payment Type*
Type Of Card
- Visa
- Mastercard
- American Express
Card Number
Card Number
Card Billing Zip*
Expiration Month
Expiration Year
Security 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.