Here's How:
Download This Form in PDF Format: Application

 

• Please download and print all applications clearly
  


• Pay is monthly
  


• Your Producer number is the last 4 digits of your social security number, please add your last name as well on all applications.
  


• To receive prompt commission, please insure that all applications are legible, filled out completely (including plan type circled on back) and are signed. A signature from both applicant and paying party (if different from applicant) must be on all applications.


• Return to:
  Direct Dental Plans of America Inc.
  11178 Huron St. Ste. 3 Northglenn, CO 80234
  303-457-9794, 800-377-2924
  Fax: 303-457-6956