ENROLLMENT FORMS - LEGALRX PLAN
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LegalRx forms:
NOTE:  Employees of FBI, USSS, DEA, ATF, CBP, CIS, and ICE must complete the SAMBA Payroll Allotment Form 299.  All other agencies must complete the Direct Debit application.
Form Description PDF Type Premium
Enrollment Form
Allotment Form 299  
Direct Debit Application Form



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