MASA MTS Emergency Shield Plan Application

Promo Code

Names and Dates of Birth

Add Spouse Upgrade to Family

Add Dependent

Contact Information

Please provide at least one phone number.

Benefits Address

? The address where services will be rendered. Our Return and Recuperation benefits will bring you, your vehicle, your dependants, etc. to this address. This is usually your primary residence.

I want my mail to go to a different address ? If you do not plan to reside at your benefits address for a majority of the year, or if you would like to receive mail at a different address, please check this box.

*For residents of the following states, please click the respective links on the right-hand side to enroll: Florida, Iowa, Kentucky, Pennsylvania, and West Virginia. MASA currently does not provide coverage to Alaska, Delaware, District of Columbia, Maryland, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Rhode Island, South Carolina, Washington, and Wyoming Residents for this product".

Mailing Address

I have read and agree to the Disclaimers and terms and conditions in the Member Service Agreement/Policy

Payment Information

Pay Annually

Auto-renew my Plan each year

Pay Monthly*

Plan Price:	$52.00
Initiation Fee:	$60.00
Total due:	$112.00

Plan Price:	$62.00
Initiation Fee:	$60.00
Total due:	$122.00

Plan Price:	$618.00
Initiation Fee:	$60.00
Total due:	$678.00

Plan Price:	$738.00
Initiation Fee:	$60.00
Total due:	$798.00

*Monthly plan automatically renew each month, unless member cancels prior to the start of the next month.

FLORIDA RESIDENTS CLICK HERE TO ENROLL

IOWA RESIDENTS CLICK HERE TO ENROLL

KENTUCKY RESIDENTS CLICK HERE TO ENROLL

PENNSYLVANIA RESIDENTS CLICK HERE TO ENROLL

WEST VIRGINIA RESIDENTS CLICK HERE TO ENROLL

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