Lookup - Quality Network Plans - providing savings to groups and individuals since 1994

JOIN

I would like to join this plan. I understand that this plan is not insurance.

All fields are mandatory:

E-Mail:

Mr Ms Mrs Miss

First and Last Name:

Street Address:

City:

State:

Zip Code:

Telephone:

Type of Plan:

	Single	$6.50/month
	Single	$65.00/year

Payment Type:

		VISA
		Master Card
		American Express
		Discover

Credit Card Number:

Expiration Date:

For monthly payment, please charge my credit card each and every month in accordance with my selection above for the amount indicated for as long as I am a plan member. The first monthly charge will include the non-refundable one-time $15.00 application fee. If you also purchase the DentAchoice program there will be only one application fee charged.

For yearly payment, please charge my credit card each and every year in accordance with my selection above for the amount indicated for as long as I am a plan member. The first yearly charge will include the non-refundable one-time $15.00 application fee. If you also purchase the DentAchoice program there will be only one application fee charged.

I permit National Benefit Builders, Inc. (NBBI) to charge my credit card for these amounts. I understand that this plan is not insurance.

I agree with the terms and conditions above.


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