Diabetic Discount Club



First Name:            Last Name:
Address:
Apt:                        City:
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Your phone # will be part of your Unique Discount ID so be sure to enter it correctly.
Date of Birth:

Why do i need to provide this?
By checking this box, I give express consent authorizing Diabetic Discount Club, Your Diabetic Source, Diabetic Specialist and agents to verify my information by contacting me via automated telephone dialing system and/or recorded messages, text and emails whether I'm on any state or federal do not call list. Giving consent is not a condition for making any purchase.

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By becoming a member of the Diabetic' Discount Club I will be eligible to receive discounts on products and services that I select interest in. Some of the services such as the discounted or no cost prescriptions and medical supplies may require verification of qualification and I understand that I may receive a call from such providers, even if I'm on a do-not-call list of any local, state or federal agency.

"CONSUMER ADVISORY: It has come to our attention that the Diabetic Discount Club brand may have been used by unathorized entities. If you have not registered to the club through an ad, a contest or any of our advertisements and have been contacted please report it by notifying the fraud department : 206-339-5669"

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