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: Producer Services
P.O. Box 401086
Las Vegas, NV 89140
Fax (949) 270-0117

Producer Application
Producer Agreement
Assignment of Commissions

If you have any questions regarding this Agreement, please contact our General Manager of Nevada Operations at (888) 401-1128 ext: 128.

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!