Marketing Service Agreement LIBERTY Dental Plan

Thank you for your interest in promoting our dental plans. Please review the Marketing Service Agreement form and complete the requested information on page three. Be sure to sign the agreement. Please attach the documents listed below and return to:

LIBERTY Dental Plan

Attn: Client Services
P.O. Box 26110
Santa Ana, CA 92799-6110
Fax (949) 270-0114

Marekting Service Agreement
Form W-9
Current California Insurance License

If you have any questions regarding this Agreement, please contact our Client Services Department at (888) 703-6999.

Once we receive your executed agreement and supporting documents, you will receive notification of your LIBERTY Dental Plan assigned Agent/Broker number. This number is to be used on all documents you submit to LIBERTY Dental Plan.

We look forward to working with you to bring access to quality dental benefits to your clients!