Becoming a Delta Dental agent is quick and easy. To get started, determine whether you should sign the Agency/Agent agreement as an individual agent or as an agency.
Agency/Agent Agreement Form:
If you’re an individual agent:
(Not associated with an agency)
Download and complete the Agency/Agent Agreement Form above. Use your name, address, phone number and fax number for commission payments.
Along with the form, also include:
- A copy of your individual producer’s license
- A completed W-9
- Your Social Security number (required by the state).
If you’re signing the agreement on behalf of your agency:
Check with Delta Dental to see if your agency already has an active agreement on file.
If your agency has an active agreement with Delta Dental, a company officer will need to notify us in writing that you are an agent at this agency. Please provide:
- Your start date
- A copy of your license
- Your Social Security number
If your agency does not have an active agreement with Delta Dental, please have an officer sign the agreement for the appropriate state. The agreement is with the agency rather than individual agents, which is why an authorized person must sign it.
Download the Agency/Agency Agreement Form and also provide:
- A copy of your agency’s license
- A completed W-9
- Copies of all the producers’ licenses
- All the producers’ Social Security numbers (required by the state).
Please email all pages of the agreement to Delta Dental, Attn: Agent Services at email@example.com.
Agent licensing inquiries only: 517-381-4235.
NOTE: At this time, we do not offer agent commissions for individual dental sales.
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