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Why You Should Join AHB
Join One of the Highest Paying Affiliate Programs in the Industry!

No Minimum Quotas Required

Leads & Live Call Transfers available



No Licensing Required

No Experience Necessary

Monthly Residual Income



Join Us Today!
Representative Application
Primary Cardholder's Personal Information Should Be Listed Directly Below
First Name:       Middle Initial:        Last Name:
Street:       Apt:
City:     State:     Zip:
Home Phone:     Cell Phone:     Fax:
Email:
SS# (required for commission payment):    DOB:     Gender: M F
Dependents
Dependents Name
(1st, M.I., Last)
Date of Birth
Relationship
Additional Comments
Plan (optional)
Key Silver
(Not available in FL, KS, VT)
Includes: Hospitalization and Facilities with Medical Health Assistance, Physicians and Specialists, Doctors Online, Dental, Prescriptions, Vision, Chiropractic, Alternative Medicine Specialists, Diabetic Supplies, 24-Hour Nurse Assistance Hotline, Hearing, Medical Travel Assist, Vitamin & Herbal Supplements and Travel Services. Bonus - ConsultADoctor™!
$37.00 a month

 

Individual

Family
Key Silver Florida
(Only available in Fl)
Includes: Hospitalization and Facilities with Medical Health Assistance, Physicians and Specialists, Doctors Online, Dental, Prescriptions, Vision, Chiropractic, Alternative Medicine Specialists, Diabetic Supplies, 24-Hour Nurse Assistance Hotline, Hearing, Medical Travel Assist, Vitamin & Herbal Supplements and Travel Services.
$30.00 a month

 

Individual

Family

Payment Choice: Monthly  Quarterly
Choose Representative Option
Independent Representative: (Set up fee non-refundable)
$59.95
Qualified Representative: (Set up fee non-refundable)
      Set up fee $59.95 plus Key Silver $37.00/Month:
      (Sign up in Key Silver Required)
$96.95
Qualified Representative Florida: (Set up fee non-refundable)
      Set up fee $59.95 plus Key Silver Fl $30.00/Month
      (Sign up in Key Silver FL Required)
$89.95
 
Choose Payment Option
Credit Card Billing
I hereby authorize Affordable Health & Benefits to charge the above funds to my selected Credit Card based on the options I chose above. I agree that if any charge is dishonored, whether intentionally or inadvertently, AHB shall be under no liability and my application will not be processed.
Credit Card Number (no spaces):   Expiration Date (mo/yr):
Billing Address :
Street Address: Apt:
City:     State:     Zip:  
Automatic Funds Transfer
I hereby authorize Affordable Health & Benefits to charge the above funds to my selected bank account based on the options I chose above. I agree that if any charge is dishonored, whether intentionally or inadvertently, AHB shall be under no liability and my application will not be processed.
Bank Name:
Bank Routing Number:      Bank Account Number:
Representative that sent you to this site:
Name:          ID Number:
Explanation of Medical Savings & Service Program
I wish to join the AHB membership plan. This plan is not insurance. Members are responsible for paying the providers promptly for all services received when accessing AHB’s networks. Actual savings will vary depending on the region and the type of specific services provided. AHB savings programs cannot be used in conjunction with any similar style program. All listed or quoted prices or fees are current prices at the date of publication and are subject to change. The AHB program benefits may vary in some areas and the program and providers may be modified at any time. Your new instruction kit and cards should be arriving in approximately 2 weeks.
This discount card program contains a 30-day cancellation period. A written notice is required for cancellation. For a full list of disclosures, click here
  I have read, understand and agree to above statements.


  I have read, understand and agree to the Independent Representative Agreement

Name:
 
   
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Affordable Health & Benefits.
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