{{productSelection.ProvidedByTitle}}
{{productSelection.ProvidedBySubtitle}}
{{productSelection.ProvidedByLabel}}
{{p.IndividualMonthPrice | currency}}/ Month
or
{{p.IndividualYearPrice | currency}}/ Year
{{p.FamilyMonthPrice | currency}}/ Month
or
{{p.FamilyYearPrice | currency}}/ Year
{{s.ServiceName}}
{{s.ShortDescription}}
Individual Coverage:
Services provided to the individual identified as the primary customer on a plan.
Family Coverage - Entire Household:
Services provided to primary customer extended to any of the following covered individuals as defined by the IRS: spouse or domestic partner, unmarried children under the age of 26, or any other qualifying relatives.
Full Plan Summary Document Including Insurance Details:
For full plan coverage summary details, please click here.

Provided By

{{productSelection.ProvidedByTitle}}

Product Selection

{{product.name}}
{{product.family}} Coverage

{{product.description}}
1. Coverage and Subscription Options
{{product.monthPrice | currency}}
{{product.yearPrice | currency}}

Fields marked with (*) are required

2. Customer Information
This field is required
This field is required
This field is required
This field is required
This field is required
This field is required
This field is required This field must be a valid email address
This field is required This field must contain only digits
This field must contain only digits

Fields marked with (*) are required

3. Payment
Payment Options
Payment Information
This field is required
This field is required
This field is required This field must contain only digits
This field is required
This field is required
This field is required
This field is required
This field is required
This field is required
This field is required
This field is required

Fields marked with (*) are required

4. Billing Address
This field is required
This field is required
This field is required
This field is required

Fields marked with (*) are required

5. Order Review
Customer Information
Name:
{{customer.firstName}} {{customer.lastName}}
Address:
{{customer.address1}}
{{customer.address2}}
{{customer.city}}, {{customer.state.abbreviation}} {{customer.postalCode}}
Email:
{{customer.email}}
Home Phone:
{{customer.homePhone}}
Cell Phone:
{{customer.cellPhone}}
Billing Information
Name:
{{payment.firstName}} {{payment.lastName}}
Address:
{{same}}
{{billing.address1}}
{{billing.address2}}
{{billing.city}}, {{billing.state.abbreviation}} {{billing.postalCode}}
{{customer.address1}}
{{customer.address2}}
{{customer.city}}, {{customer.state.abbreviation}} {{customer.postalCode}}
Product Product Name (Coverage, Subscription) Total
Subtotal {{total | currency}}
{{product.name}} ({{product.family}} Coverage, {{product.frequency}}) {{product.price | currency}}
Agent (Code {{appliedDiscountCode}}) ({{payment.discount | currency}})

Thank you for your purchase!

Order Summary

Customer Number: {{customer.customerNumber}}

{{product.name}}
{{product.family}} Coverage

{{product.description}}

Use this Customer Number: {{customer.customerNumber}} to complete account registration.


Web Ecommerce
Contact us today at {{productSelection.HelpPhone}} or {{productSelection.HelpEmail}}
2425 Commerce Ave NW, Suite 300, Duluth, GA 30096, USA
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