Discount Medical Plan Application
Dental, Vision, Prescription, Chiropractic, and Hearing

We Value Your Privacy
Your membership materials will arrive within 7 to 10 business days after your application is processed.

You can cancel within 30 days after receipt of membership materials and receive a full refund, less the processing fee.

FL Residents: You can cancel within 30 days of the effective date and receive a full refund, less the processing fee.

Send written cancellation requests to Careington: PO Box 2568, Frisco TX 75034; or fax to: 888 335-7330 or email: member@careington.com.

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Security Information
Careington International Corporation, Medical - Dental Discount Plans, Frisco, TX

Member Information
* Denotes Required Field
*First Name   Initial
*Last Name   Suffix
*Address
 
*City
*State
This program may not be available in all States
*Zip Code -
*Home Phone --
Work Phone --
*E-Mail Address
*Date of Birth
*Gender
Marital Status
Number of
Members

Additional members besides enrollee
*Where Did You
Hear About Us?
If other:
 
  I am interested in receiving future offers for other products or
services from Careington. I understand that my information
is not shared with other companies for any purpose.
  I have reviewed the terms and conditions and wish to purchase the discount medical plan.

Desired Billing Cycle

Members Only
 $9.95 monthly
 $90.00 annually (A 25% Savings)
Member + One
 $14.95 monthly
 $135.00 annually (A 25% Savings)
Member + Family
 $19.95 monthly
 $180.00 annually (A 25% Savings)


One-time $25.00 non-refundable processing fee.
   
*Effective Date

Payment Method
Credit/Debit Card
Bank Draft/Electronic Check



FORM CODE CICONLINEAPP
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This is not health insurance.
Terms and Conditions