Test form Signups
| Status | Active |
|---|---|
| Misc Member Notes | Member has the same address as another new member from yesterday, Roberto Castillo 1789597062. I only caught bc I recognized the same address. Called member, no answer. Will leave for now. No EM on file for either member. 09/17/26 MT |
| Membership Type | Individual Plan ($99.95) |
| Are you renewing your plan? | No |
| Your Name | Gricelda Ahumada |
| Phone | (831) 272-5825 |
| Date of Birth | 07/19/1967 |
| Enter Office Code | RG6131 |
| Address | 1521 Mesquite Dr. Salinas, CA 93906 Map It |
| Payment Method | Credit Card |
| Credit Card | visa XXXXXXXXXXXX0980 |
| 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 | 09/17/2026 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 10/17/2027 |
| Membership ID Number | 1789659979 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 1 |
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