Leo Web application forms Member Portal Primary Account Holder Registration Please complete each field with your CURRENT information. Skipped fields may cause a delay in processing your request. Upon submitting this registration, you understand and approve of the terms of use and privacy policy of LEO Web Protect. Furthermore, you approve LEO Web Protect to act as your agent in assisting you in removing your private information from the Internet. This authorization shall remain in effect until repealed in writing. Please provide the following: - A copy of your current driver’s license - Department Identification card (this information is necessary in order for websites to authenticate that the request is being made by the individual to whom the information belongs to. All pictures, driver’s license numbers, signature block and department identification numbers will be removed prior to submittal). All requests must includeFull Name First Last Aliases, if any (including maiden names) Date of Birth MM slash DD slash YYYY Social Security NumberLEO Web Protect Inc will only share your social security number with (2) websites (Lexis Nexis and Thompson Reuters). These (2) websites use your social security number to isolate and remove your information and to have your information to be rapidly remove upon its repopulation on their servers. This is the only reason we make this request. You have the option to refuse!Current Address Street Address City State / Province / Region ZIP / Postal Code Previous Address Street Address City State / Province / Region ZIP / Postal Code Phone NumbersEmail addresses 41782 Spouse Registration Please complete each field with your CURRENT information. Skipped fields may cause a delay in processing your request. Upon submitting this registration, you understand and approve of the terms of use and privacy policy of LEO Web Protect. Furthermore, you approve LEO Web Protect to act as your agent in assisting you in removing your private information from the Internet. This authorization shall remain in effect until repealed in writing. Please provide the following: -A copy of your current driver’s licenseAll requests must includeFull Name First Last Aliases, if any (including maiden names) Date of Birth MM slash DD slash YYYY Social Security NumberLEO Web Protect Inc will only share your social security number with (2) websites (Lexis Nexis and Thompson Reuters). These (2) websites use your social security number to isolate and remove your information and to have your information to be rapidly remove upon its repopulation on their servers. This is the only reason we make this request. You have the option to refuse!Current Address Street Address City State / Province / Region ZIP / Postal Code Previous Address Street Address City State / Province / Region ZIP / Postal Code Phone NumbersEmail addresses 51649
