1. Personal Information
Parent*  Explanation! 
   
   
   
   
   
   

* Parent refers to the parent that will be entering most of the expenses.
2. Expense Types
Expense Type (e.g., Medical*, School, etc.)
Primary % / First Dollar**
Second % / First Dollar**
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* For Medical Expenses add one line per child if there is a First Dollar Amount applies per child.
** The First Dollar is the amount that must be reached before the sharing percentages apply (eg., First $250 of Medical expenses are paid by Primary parent)
3. Payment Information

No amounts will be charged on your card during your free trial (default is 45 days). Your charges will automatically be charged to your credit card beginning at the billing start date below. If you choose the Annual Option, your card will be charged annual on the anniversary of the billing start date. By submitting this form you are agreeing to these recurring charges. Once you are logged in you will have the ability to cancel at any time, as well as update or change your credit card information.




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12/03/2017

Credit Card Options
4. Confirmation
Thank you. You are all set
We will process your submission and email you when your system is configured for your use.
Below is a summary of your submission information:


Profile Information



Second Parent Not Included
Start/Effective Date:


Expense Types

-

Payment Information

-Select- /-Year-


Your credit card was not charged today. You signed up for billing and your first charge of $ will appear on your credit card on December Incorrect data type for operator or @Function: Time/Date expected, 2017

Fullname1:
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Fullname1:
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