Printable Application
Use this to Fax or Mail in your application

1. Complete the form
   
   
2. Mail or Fax it to the Team Liberty Benefits.
   
   
3. Your material packet and identification card(s) will arrive in 7 to 10 days.
   
   
4. Print out the home delivery order form below.
   
   
5. Customer sales representative will assist you with any questions.
   
   
6. Mail or Fax the form and receive your medication(s) in 7 to 10 Days
   

Online Application
100% Secure

1. Complete the online form.
   
   
2. Print out the confirmation page with your new Liberty ID number.
   
   
3. Print out the home delivery order form below.
   
   
4. Call the phone number on the form with your Liberty ID number.
   
   
5. Customer sales representative will assist you with any questions.
   
   
6. Mail or Fax the form and receive your medication(s) in 7 to 10 Days