Test form Signups
| Status | Active |
|---|---|
| Misc Member Notes | Sending a check in for the renewal 1/24/19 EK Member called in to request receipts for her payments for the last two years by email. I verified the email we have on file for her. She requested it by 10am tomorrow for her taxes meeting. I let her know another dept handles that, but I will put in the request. 2/5/2021 MT Member called to find orthodontist in their area. 07/18/25 MT ExMail 2/4/19, ExMail 3/25/21, ExMail 5/10/2022, ExMail 6/14/23, ExMail 6/28/24, ExMail 08/20/2025, Member still wants an orthodontist. I found one close but she was told they do not take DC. Next closest is about 5 miles out which she says is too far. Calling office to explain DC – I called closest offices but they do not take discount plans. I found one that will accept, but about 14 miles away. I emailed her w/ my findings. 9/29/26 EK |
| Membership Type | Individual Plan ($99.95) |
| Are you renewing your plan? | Yes |
| Please enter your current membership ID# here. You can find this in your renewal email or on your current membership card. | 1755701427 |
| Your Name | Rita Tramontin |
| Email hidden; Javascript is required. | |
| Phone | (734) 973-1519 |
| Date of Birth | 01/16/1962 |
| Referred by or Referral Code | Todd Tramontin 8035294087 -done, ExMail 09/24/26 |
| Address | 2581 Crystal Dr Ann Arbor, MI 48108 Map It |
| Payment Method | Check |
| Payment Received | Paid |
| 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 | 10/01/2026 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 11/01/2027 |
| Membership ID Number | 1790266406 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 8 |
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