Associate Registration

POA Badge

*Additional household members for an existing subscription only.

Additional household members for a new subscription can be added on a later page.

Fill out a limited information sheet, LEO Web Protect will take care of the rest….

Faxes and emails sent to databases to have your personal information removed.

Follow up to make sure your personal information has been successfully removed.

Monthly audits to make sure any new information on you is removed immediately.

*Primary Member Name

*Relation to Primary Member

*First Name

Middle Name
REQUIRED

*No middle name

Check box if you don’t have a middle name

*Last Name

Maiden Name

*Date of Birth

Social Security #

*Primary Phone

Secondary Phone

*Personal Email

*Street Address

*City

State

*Zip Code
Driver's License
If you have the ability to attach a copy of your Driver's License, please attach it here.

Select file(s) (max file size 64 MB)

Department ID
If you are also a member of law enforcement and you have the ability to attach a copy of your Department ID, please attach it here.

Department ID

Please be advised, you can proceed without providing your IDs. We will contact all clients and request these IDs at a later date. LEO Web Protect cannot remove your information without your IDs. Those who are unable to make copies of their law enforcement IDs (e.g. members of DHS), your law enforcement business card will suffice.

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Select file(s) (max file size 64 MB)

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