Test form Signups

By On February 26, 2026 0 Comment
StatusFuture
Misc Member Notes

Lost new mcards, added to resend list. 7/8/19 JC
Norman called in, LVM last night, said he wondered if his friend Michael Glick signed up and mentioned him. Said that Michael said nobody asked him about who referred him so he might have signed up with someone else. I told him we would investigate and thanked him for referring people. Does not appear michael is member with us. 04/14/21 JC
Norman called back regarding above. I let him know we do not show Michael Glick as a member w/ us, or any history of speaking w/ him 4/14/21 EK
Member called in said they got email about some materials to promote plan, told him we will get them mailed out soon. 01/13/22 JC
sent. 01/14/22 JC
Member asked for a discount as they are iffy about renewing/tight on money etc. I gave senior discount 12/15/22 EK
Member lost cards, resent EM, added to resend master 2/22/23 EK

Member has insurance now and probably not renewing at this time 2/8/24 EK

Membership TypeIndividual 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.1760471229
Your NameNorman Kabert
EmailEmail hidden; Javascript is required.
Phone(216) 210-6283
Date of Birth01/04/1938
Referred by or Referral CodeBPresser 61076410693 DONE
Enter Office CodeAJ386
Address16695 Chillicothe Rd
Apt 237
Chagrin Falls, OH 44023
Map It
Payment MethodCredit Card
Credit Carddiscover
XXXXXXXXXXXX0258
Total$99.95
Go Green | Paperless Optionnot
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 here11/29/2026
Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here12/29/2027
Membership ID Number1791850742
Past Plan Informationthis probably isn't needed there should already be additional entries
Resend Sign Up Email8
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