Payment Authorization: You authorize Agentra or its approved affiliate / marketing partner(s) to charge the debit card, credit card or ACH bank account as indicated in this authorization on behalf of the Insurance Companies and benefit providers, and their respective plans which you have selected. Furthermore, you acknowledge and agree that future payments may be charged to the debit card, credit card or ACH bank account you have provided on a recurring monthly basis with your full authorization for the amount associated with the products and services selected above. If the above noted payment date falls on a weekend or holiday, you understand that the payment may be executed on the prior business day. You understand that this authorization will remain in effect until you cancel it in writing, and you agree to notify Agentra in writing of any changes in your account information or termination of this authorization at least 15 days prior to the next billing date. You certify that you are an authorized user of this debit card, credit card or bank account and that you will not dispute the scheduled payments with your Credit Card Company or bank provided the transactions correspond to the terms indicated in this authorization form.

Cancellation / Refund Policy: You will have 10 days from your effective date to review the materials. This period is referred to as a "free look" period and means that if within those 10 days you change your mind about the purchase, you can cancel for a full refund, provided you furnish written notification to Member Services within the "free look" period. Policies returned within the free look period will be terminated back to the effective date and you will forfeit any potential claims in lieu of your refund. Any cancellation requests received after the free look period are subject to a 10-day minimum cancellation notice, and the cancellation will become effective at the end of the coverage period, no earlier than 10 days after receipt of the written cancellation request.

Electronic Signature (eSignature): You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action during the enrollment in the products and services offered; or in accessing or making any transactions regarding the products and services offered; agreement; acknowledgement; consent; term; disclosure; or condition constitutes your signature, acceptance and agreement as if actually signed by you in writing. Further, you agree that no certification authority or other third party verification is necessary to validate your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or resulting contract between you and VSECU. You understand and agree that your eSignature executed in conjunction with the electronic submission of your application will be legally binding and such transaction will be considered authorized by you.