Test form Signups
| Status | Active |
|---|---|
| Misc Member Notes | Same last name/address as member Alicia Ruelas. Calling after 12pm to see if they want fam plan.//Called number on file for Ruben, got an auto message for home warranty?? Called the other number for Alicia, got message in Spanish. 09/17/26 MT |
| Membership Type | Individual Plan ($99.95) |
| Are you renewing your plan? | No |
| Your Name | Ruben Ruelas |
| Email hidden; Javascript is required. | |
| Phone | (831) 778-9143 |
| Date of Birth | 03/29/2001 |
| Enter Office Code | RG6131 |
| Address | 253 San Juan Grade Rd Salinas, CA 93906 Map It |
| Payment Method | Credit Card |
| Credit Card | visa XXXXXXXXXXXX6883 |
| Total | $99.95 |
| Go Green | Paperless Option | not |
| Terms |  I have read the Terms and Conditions and wish to purchase the Discount Medical Plan. |
| Plan Information | |
| Newest Membership: Programmatically pick Plan Start Date Based on either new plan or their ID number here | 09/16/2026 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 10/16/2027 |
| Membership ID Number | 1789596855 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 1 |
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