New Member Premium Registration Form (Already a member? Sign-in here) Registration InfoStep 1 of 9 User Email * User Password * Confirm Email * Confirm Password * WILZIL AGREEMENT • This website is designed to assist your loved ones with additional wishes you may have and to assist you in planning and organizing your wishes and thoughts. • This website does not replace your will, trusts, powers of attorney, health care surrogates and living wills you may have. “I agree to the terms and conditions as set out by the user agreement creating a Wilzil.com account." **Agree Designee Info Designee #1 First Name Designee #1 Last Name Date of Birth Phone # Designee #1 Email Address - Street Address Apartment/Suite# (if any) City State Zip Country of Residence Child Info (if any) Child #1 First Name Child #1 Last Name Date of Birth Phone # Child #1 Email Address - Street Address Apartment/Suite# (if any) City State Zip Country of Residence Do you have a Will? * Yes No Do you have a Trust? * Yes No Do you have a burial preference? * Yes No No Preference Are there any traditions/customs or wishes you would like to be included?: 0 characters Have you made any funeral arrangements? * Yes No Do you have any pets? Yes No Do you have any social media accounts you wish to keep active? Yes No -If yes, please list below details and for how long. 0 characters How long do you wish to keep your WilZil account active after final payment? Do you have any photos you'd like to upload to be used? Drop your file here or click here to upload You can upload up to 1 files Drop your file here or click here to upload You can upload up to 1 files Drop your file here or click here to upload You can upload up to 1 files Life Insurance Life Insurance Company Life Insurance Company - Policy Owner Policy Owner - Beneficiary Beneficiary Please use the space below to list any additional details for your Designees. 0 characters Please Tell Us... How did you hear about WilZil? 0 characters Disclaimer: Trustee under your Living Trust: Responsible for managing property titled in the name of your Living Trust. Most people make themselves the initial Trustee(s), and designate Successor Trustee(s) who will serve when they can no longer act due to disability, or death. Personal Representative under your Last Will & Testament: Responsible for probating your Will, if probate is necessary, and administering your probatable assets. Agent under your Durable Property Power of Attorney: Responsible for handling your personal financial affairs that are not in your Trust, including, but not limited to, real estate sales, bank account transactions, execution of contracts, tax returns and motor vehicle registrations. BENEFICIARIES: These are the individuals (and/or organizations) you wish to receive your assets upon your death. Designee PIN* Enter a 4 digit PIN # to be emailed to designee *Do not change* Do you wish to add a secondary designee? * Yes No Real Estate Owned Address 0 characters Address 0 characters - OwnerIndividual Joint Trust Other - OwnerIndividual Joint Trust Other Designee #2 First Name Designee #2 Last Name Date of Birth Phone # Designee #2 Email Address Street Address Apartment/Suite# (if any) City State Zip Country of Residence Do you wish to add a secondary child? *Yes No Child #2 First Name Child #2 Last Name Date of Birth Phone # Child #2 Email Address Street Address Apartment/Suite# (if any) City State Zip Country of Residence Personal Info First Name * Last Name * Date of Birth * Street Address * Apartment/Suite# (if any) City * State * Zip Code * Country of Residence * Phone # * Plan & Payment Info Premium Plan (Renews every month) * *By checking this box, you agree to pay $199.99 due today, and will renew monthly at a membership rate of $6.99 each month after. - USD $199.99 Stripe Gateway Credit Card Card Billing Information Do you wish to add a third child? *Yes No Child #3 First Name Child #3 Last Name Date of Birth Phone # Child #3 Email Address Street Address Apartment/Suite# (if any) City State Zip Country of Residence Do you wish to add a fourth child? *Yes No Child #4 First Name Child #4 Last Name Date of Birth Phone # Child #4 Email Address Street Address Apartment/Suite# (if any) City State Zip Country of Residence Cardholder First Name Cardholder Last Name Email Phone Billing Address 1 Apt/Suite# (if any) Billing City Billing State Billing Zip PreviousNext Save
