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You can enroll online or download the paper application below.

If you enroll online, you can choose to pay monthly via credit/debit or bank withdrawal. Charges will be made within the first five business days of each month.

Enroll Online

If you enroll via paper application, you will need to send a check along with your application in the amount of one year’s premium (you can find these totals on the paper application). 

Delta Dental Individual & Family Paper Application

Please note: applications, online or paper, must be received on or before the 25th of the month for coverage to start the first of the following month. Your rates are guaranteed for one year. 

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