ARAG Legal Insurance Intake Form

"*" indicates required fields

Name*

First Last

Email*

We'll use this to follow up about your ARAG coverage.

Phone

Optional, but helpful if we need to call you.

ARAG Member Information

ARAG Membership Number*

As shown on your ARAG card.

ARAG Case ID / Claim Number*

Provided when you opened your matter with ARAG.

Additional Information

Anything else you'd like us to know about your situation or your ARAG plan?

By submitting this form, you authorize Estate Plan HQ to verify your ARAG membership and coverage with ARAG. You understand that Estate Plan HQ will not ask you to pay directly for your estate plan if ARAG confirms your coverage. Our team will follow up with you to complete your plan intake.

Untitled*

I confirm the information above is accurate and I authorize Estate Plan HQ to verify my ARAG coverage.

This field is for validation purposes and should be left unchanged.

ARAG Lead Intake

ARAG Legal Insurance Intake Form

ARAG Member Information