Thank you

You have finished the first step in enrolling in Connection Dental Plus. If you selected "Quarterly billing from Connection Dental Plus" as your payment option, there's nothing more you need to do. We will process your form and be in touch.

If you selected "Monthly bank draft from Checking or Savings" or "Quarterly bank draft from Checking or Savings," please continue with Step 2 ...

Step 2: Complete the Bank Draft Authorization Form

This form is required for monthly or quarterly Bank Draft. Bank Draft is available from a checking or savings account. We will contact your bank to set up the automatic draft for premium payment. If you need help with this form, or have any questions, please call us at 800.793.9335.