DocuBank® Financial Advisors
Application To begin enrolling
your clients in DocuBank, please complete and submit the
application below. Please note: As of
May 1, 2005, DocuBank has instituted an Account Set Up fee.
Financial Advisor's Name: *
Firm Name:
Office Phone
Number: *
Address:
City: *
State: Zip:
Email Address: *
I plan to include
DocuBank for my clients beginning (date)
I plan to include the
following membership type within the lump sum fee for each estate
plan:
One-Year Membership Five-Year
Membership
I currently use:
WordPerfect Word
Other
The person in my office
who operates our software is:
Name:
Title:
The person in my office
who will oversee enrolling my clients in DocuBank®
(mailing enrollment forms, health care documents and payments) is:
Name:
Title:
The person(s) (in
addition to the Financial Advisor) who will be speaking to clients about
DocuBank® are:
Name:
Title:
Name:
The estate planning
software I currently use is
Please PRINT exactly
how would like your name and/or firm information to appear on your
clients' DocuBank® Emergency Cards. You
customize the text.
(1st
Line)
(2nd Line)
Please schedule a telephone conference with me (approx. 10 min.)
I understand that
DocuBank® stores my clients' legal healthcare
documents and is not responsible for verifying the accuracy or
completeness of documents provided to DocuBank® .
I also understand that DocuBank® does not store
medical information and does not accept responsibility for the
accuracy, completeness or updating of any medical information sent
to DocuBank® .
Signature (Typing your name here will be
considered a valid signature and an assent to the paragraph
directly above.)
