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Add Optional Benefits
Careington Discount Dental Plan:   


   *Not availiable in Vermont or Washington

Association Rx Card:  


   *Not availiable in South Carolina


THE ADDITIONAL BENEFITS ABOVE ARE DISCOUNTED PROGRAMS, NOT INSURANCE. DISCOUNTED FEES ARE DUE AT THE TIME OF SERVICE


Enter your information



Enter dependent information

You may choose dependents to be covered below.

Note: Dependents age 19 to 24 must be full time students.

Association Rx Card

Please check all individuals to be covered on the Association RX Card.
(NOTE: Children 19 to 23 must be full time students)

(Member)

I authorize the Association, the Pharmacy Services Administrator and its participating pharmacies to share only information necessary to the fullfillment of prescriptions

NOTE: Pricing and tier position are subject to change without notice. Tier position and pricing is only for quantities stated, additional quantities may incur higher costs. Association Rx Card is not insurance. This application is not a contract. For complete details, consult your fulfillment materials




Chose your billing method

Membership Costs
AFS Independence Package – Single
$30
Upgrade options amount:
One-time administration fee:
$25
Total First Payment

Credit card information

For the purpose of honoring debits or credits for collection of initial dues initiated by AFS I authorize AFS to charge the credit card or debit card account identified as the "Account" for up to the amount specified and to receive payment of such amount from the Account for payment of initial dues, administration fee and Association products selected to join the Association. I understand and agree that (i) Association membership will not become effective unless and until payment of the full amount of initial dues shall have been received by the Association, (ii) any charge made pursuant to this authorization will be made for payment of the initial dues & fee only, (iii) reversal or contest of, or objection to, any charge made pursuant to this authorization shall constitute failure to pay initial dues in full which will automatically terminate and void the Association membership, (iv) the issuer of any credit card or debit card to be charged pursuant to this authorization is not acting and will not act as an agent of either the Association or me in accepting and paying the charge authorized hereby and (v) charge will be made immediately upon Association receiving this authorization.


Electronic Check - Bank Account Information

Automatic Draft:

I authorize Americans for Financial Security to debit entries to my account with the depository named for the purpose of honoring charges initiated by AFS. This authorization will remain in effect until the company has received notification from me that it is to be terminated in such a time and manner for the company to act on it. I have the right to stop payment of a debit entry by notification to Depository at such time as to afford Depository a reasonable opportunity to act on it prior to charging account. After account has been charged, I have the right to have the amount of an erroneous debit immediately credited to my account by Depository, provided I send written notice of such debit entry in error to Depository within 15 days following issuance of the account statement or 45 days after posting, whichever comes first.

NOTE: If Draft Payment is selected Membership Start Date will be the draft day, after initial payment is applied. If any date above 28 is selected the ongoing draft date will be the 28th.


Electronic Signature

I wish to make application for membership in Americans for Financial Security (AFS). I understand benefits are offered at the sole discretion of AFS and may vary by availability, vendor, or state of residence of the Member. Vendors reserve the right to withdraw or change their offers without notice. The benefit descriptions have been taken from the benefit providers’ marketing material and members should carefully examine benefit information before choosing any benefit. AFS makes no affirmation of fact or promise relating to the goods and services and specifically disclaims any warranty, expressed or implied, as to the merchantability of the goods and services reflected. To be entitled to AFS benefits, you must be a member in good standing and dues must be paid current. AFS does not verify eligibility status on benefits. Each vendor has the responsibility and right upon claims or services submitted against a benefit to honor or deny service. All information collected by the Field Service Representative in connection with this application for Membership is utilized solely for the purpose of providing Association benefits. Monies collected prior to cancellation are non refundable. Should I choose to cancel my AFS Membership, I understand I must contact AFS at 1-800-492-1016 or write to AFS at P.O. Box 141268, Irving, TX 75014-1268 or via facsimile to 1-800-468-6724.

By checking the box and entering my name below, I am indicating my intent to electronically sign this application and warrant that all of the information I have provided is true, complete, and accurate.

Please enter your name in the spaces below to electronically sign your application.

Please re-enter to confirm your application


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