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Www. amerilawyer. com/LivingTrusts CALIFORNIA REVOCABLE LIVING TRUST FAX ORDER FORM Instructions Please complete and fax this sheet Toll Free 1 800 520 7800 to begin the process of forming your California Revocable Living Trust. Spiegel Utrera P. C. will contact you to review your details and to provide answers to all your business formation needs. CONTACT INFORMATION Full Name Your daytime phone number Your fax number Email address Your address Please CHECK the box for the type of Living Trust you are ordering Individual Revocable Living Trust 99. 95 Joint Revocable Living Trust 169. 95 Marital Exemption A/B Revocable Living Trust 199. 95 INITIAL TRUST DETAILS Name of your Trust When we contact you please be sure to have the names contact information and social security numbers of the parties that you would like to be included in the Trust. Spiegel Utrera P. C. General Counsel Club Specific Durable Power of Attorney Indemnification Agreement General Durable Power of Attorney Personal Power for Trust Anatomical Gift Declaration Incapacity Protection Provisions in the Trust Pour-Over Will with Guardian Provisions Asset Segregation Provisions in the Trust Pour-Over Last Will Testament Creditor Protection in the Trust Memorandum of Trust Living Will Verified Certificate of Trust Donation of Organ Declaration HIPAA - Health Insurance Portability and Primary Physician Designation Accountability Act Release Authority Power of Attorney for Healthcare HIPAA Consent Document Remember to visit www. Amerilawyer. com/LivingTrusts for a complete list of services. SPEED OF SERVICE NO RUSH - Please provide me with your regular 2-3 week service. IN A HURRY - Please provide me with your Fast Service 3 business days NEXT DAY - Please provide me with Next Day Service SHIPPING DETAILS Trust Collection Packages weigh approximately 2 pounds and may be shipped to you via Regular 2-3 day Service via Overnight Delivery or may be picked up at anyone of our office locations. PAYMENT OPTIONS After we review your order how will you be paying for this service Please provide payment information* Please note NO charges will be processed until you are contacted by Spiegel Utrera P. C. Credit Card VISA MasterCard American Express Discover PayPal Credit Card Number Expiration Date Card ID Number Name on Credit Card Billing Address on Credit Card Authorized Signature To place this order online please visit us at www. Spiegel Utrera P. C. will contact you to review your details and to provide answers to all your business formation needs. CONTACT INFORMATION Full Name Your daytime phone number Your fax number Email address Your address Please CHECK the box for the type of Living Trust you are ordering Individual Revocable Living Trust 99. CONTACT INFORMATION Full Name Your daytime phone number Your fax number Email address Your address Please CHECK the box for the type of Living Trust you are ordering Individual Revocable Living Trust 99. 95 Joint Revocable Living Trust 169. 95 Marital Exemption A/B Revocable Living Trust 199. 95 INITIAL TRUST DETAILS Name of your Trust When we contact you please be sure to have the names contact information and social security numbers of the parties that you would like to be included in the Trust.

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