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Mail Service Subscription Agreement

Subscriber name(s):
Phone #
Escapees RV Club Membership #
Email:

Mail Service Category

Additional names, middle names, former names, maiden names, nicknames, initials, and business names*
(Split across two lines as they appear on mail)





With proper documentation, also please list: POA, Deceased, Trust, etc.
(Use these two lines if you have Power of Attorney, deceased persons, trusts, etc.)





Emergency Contact Information (DO NOT LIST ACCOUNT HOLDERS)
Contact 1 Name:
Phone:
Relationship:
Contact 2 Name:
Phone:
Relationship:
In the event of Subscriber's death or incapacity, I authorize the following person as my authorized agent for purposes of this agreement; however, legal documentation if provided will supersede this.
Authorized Agent:
Phone:
Relationship:



Subscriber Signature (required)
Second Signature (optional)