Individual Information
Member Information
First Name
* Please Enter First Name.
Last Name
* Please Enter Last Name.
Suffix
Email
* Please Enter Email. Please Enter Correct Email.
Phone
Phone number should be 10 digits.
Address
* Please Enter Address.
City
* Please Enter City.
State
*
Please Enter State.
Zip Code
* Please Enter ZIP Code. ZIP Code should be 5 digits.
Date of Birth
*
Please Select Month.
*
Please Select Date.
*
Please Select Year.
Gender
*
Please Select Gender.
Language
*
Please Select A Language.
Notification Method
*
Please Select Notification Method.
Best Time To Call
*
Please Select Best Time To Call.
Effective Date
*
Please Select Effective Date.
Agent ID
Payment Information
Select Payment Method
First Name
* Please Enter Billing First Name.
Last Name
* Please Enter Billing Last Name.
Address
* Please Enter Billing Address.
City
* Please Enter Billing City.
State
*
Please Enter Billing State.
Zip Code
* Please Enter Billing ZIP Code. ZIP Code should be 5 digits.
Accepted Payment Method Visa, MasterCard, American Express, Discover
Credit Card Number
*
(no spaces or hyphens please)
Please Enter Card Number.
CVC/CCV Code
* (What's this?)
Please Enter CVC Code.
Expiration Date
*
Please Select Expiry Month.
 
*
Please Select Expiry Year.
Bank Details
Name On Account
Account Type
*
Please Select Account Type
Routing Number
* Please enter Routing Number.
Account Number
* Please enter Account Number.
Bank Name
 
Purchase confirmation
{{purchaseInfo['productdescription']}}{{purchaseInfo['unitprice']|currency:"$":2}}
Total Charged {{totalPrice|currency:"$":2}}

You agree to pay Transparent Healthcare’s Monthly membership fee of  {{monthlyTotalPrice|currency:"$":2}} and One Time membership fee of  {{oneTimeTotalPrice|currency:"$":2}} , which will be automatically charged to your preferred payment type. You have a 30 day no risk money back guarantee, and can cancel at any time. After the first 30 day period, any paid membership fees are non-refundable.

   * I agree to the Transparent Healthcare terms and conditions found at www.careicanafford.com and I agree to the purchase terms detailed above.
Please agree to the terms and conditions.
Thank you for joining Transparent Healthcare. You should receive your membership card and welcome materials within 5-7 business days. If you have any questions, or to access your services immediately, please call our customer service at (877) 571-8950 or email support@transparenthealthgroup.com