SUBMIT DOCUMENTS
Member’s Full Name
*
First Name
Middle Name
Last Name
Client Code / Account Number
Example: MCMABRP
Claim #
Example: 1234
Cell Phone/Other
-
Area Code
Phone Number
Description of Documents
*
Please provide a detailed description of the documents uploaded.
E-mail
*
(example@example.com) We recommend personal Email
Please scan and attach any documentation that you may need to submit to PLEA.
Browse Files
PDF documents are preferred.
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