Group Enrollment Form

Enrolling Is Easy
Enrolling your company in one of our group dental plans is easy. Simply download, print and complete the Group Administrative Agreement and fax or mail it to us. We would also need the completed Enrollment Cards for all employees who wish to join our dental plan plus a check for the first month's premium. The first month's premium calculation page can be found in the Download Materials Section.

Need Additional Assistance?
We are available to provide you with the assistance that you need to insure a smooth enrollment for you and your employees.

For additional assistance please contact us.