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The best way to enroll in DocuBank is through an estate planning professional. To find a DocuBank Provider in your area, please call us at 866-829-0993.

To enroll on your own: Complete the enrollment form below. Next, print it out and sign it.

Send the following materials to DocuBank:

The completed enrollment form (signed).
A signed copy of your Healthcare Directives (Living Will, Healthcare Power of Attorney, organ donation form). Note: We do not require original documents.
Your payment — check for $65 for one year / $150 for three years / $235 for five years; or credit card information).

Mail the enrollment materials to:
DocuBank
PO Box 629
Springfield, PA 19064

A. Personal Information

* Email Address

Prefix

* First Name

M.I.

* Last Name

Suffix

* Mailing Address

* City/Municipality

* State

* Zip Code

* Primary Phone Number

Alternate Phone Number

Date of Birth

Allergies

You have / characters remaining

Medical Conditions

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Additional Note

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B. Emergency Contact: (Optional)

The name and phone numbers of your primary emergency contact will be listed on your card. Additional contacts can be added online when your membership is active and will be provided to hospital staff when your documents are requested. Please provide your primary contact information below.

First Name

Last Name

Home Phone

Work Phone

Cell Phone

Email Address

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