You are taking a big step in creating FREEDOM AT HOME. We look forward to talking with you. For immediate consideration for a position with our company, please fill out the form below for an interview.

We value your privacy, your information is strictly confidential. We do not sell email addresses or phone numbers.

Please be sure to add my e-mail address: to your accepted senders list to ensure deliverability of your interview confirmation as well as information you will need prior to your phone interview.

Must be 18 years or older to request an interview.

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*First Name:
*Last Name:
*E-mail Address:
*Day Phone:
Evening Phone:
Best Time to Call:
Time Zone:
Home Address:
Address 1:
Address 2:
State/Prov: Zip Code:

What would you like for us to know about you?

How did you hear about our site?

When would you like to start working at home?

How much extra monthly income would you like to earn?

How long are you willing to work to attain your income goals?

How many hours per week can you invest in your business?

Do you have a dental, vision prescription or chiropractic plan?

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Do you have a medical plan?

Yes No

Even though I am on a National or State DO NOT CALL List, by submitting my contact information which includes my telephone number, you are authorized to contact me by telephone or email at that number/email regarding the AmeriPlan® Business Opportunity for the three (3) month period following date of this consent.

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The AmeriPlan® Health discount medical plans offer a reduction in the cost of medical, dental, vision, pharmaceutical and chiropractic services. AmeriPlan® Health benefit programs are not insurance, nor are they an alternative to or substitution for insurance coverage. Since they are not health insurance, members must use AmeriPlan® providers and members are responsible for payment to the AmeriPlan® providers at point of service of discount healthcare fees incurred. If you currently have insurance, you should be aware that canceling that policy may make it difficult to later obtain coverage. AmeriPlan® Health recommends that you speak to your insurance agent or your company's insurance administrator before canceling any health insurance policy for any reason.