DISCOUNT PLAN APPLICATION
DENTRITE® DISCOUNT PLAN
Products Included: DENTAL, HEARING, LASIK VISION CORRECTION, PRESCRIPTION, VISION
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Step 1: Billing Options

Select a billing option:
 
Member Only
Member Plus Family




*Plus a one-time non-refundable processing fee of $10.00

Coupon/Promo Code: (optional)

ReferralCode :

$99.00 billed annually  + $10.00 one time non-refundable processing fee

Total = $109.00 will be charged for your first year; $99.00 will be charged annually thereafter



When would you like your membership plan to start?

 

FORM CODE DNRTONLINEAPP


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