Start – Dental Care $50 – Sociallity Members

Dental Care Service Enrollment

FULL YEAR OF SERVICE | UNLIMITED USAGE | INCLUDES MEMBER AND ALL HOUSEHOLD DEPENDENTS

Yearly Subscription Fee: $50.00

Product Cost
HOME STATE*
THE DENTEMAX DENTAL SAVINGS PROGRAM IS CURRENTLY NOT OFFERED TO RESIDENTS OF YOUR STATE AS A STANDALONE PRODUCT. IF YOU ARE A RESIDENT OF A DIFFERENT STATE, PLEASE SELECT THE APPROPRIATE STATE ABOVE.

ALTHOUGH WE ARE NOT ABLE TO ENROLL YOU IN THE DENTAL SAVINGS PROGRAM, YOU MAY STILL ENROLL IN THE FLEXIBLE ACCESSNOW PROGRAM, WHERE A BROAD RANGE OF SERVICES ARE AVAILABLE FOR RESIDENTS IN YOUR HOME STATE.
GREAT NEWS!! THE DENTEMAX DENTAL SAVINGS PROGRAM IS ACTIVE WITHOUT RESTRICTIONS IN YOUR STATE.

PLEASE COMPLETE THE ENROLLMENT PROCESS TO ACTIVATE THE DENTAL CARE SAVINGS PROGRAM.
PAYMENT INFORMATION*

American Express
Discover
MasterCard
Visa
CARD NUMBER EXPIRATION DATE SECURITY CODE CARDHOLDER NAME
BILLING ADDRESS*
STREET ADDRESS CITY STATE ZIP CODE
MEMBER NAME*
FIRST LAST
MAILING ADDRESS*
USE MY BILLING ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

WE WIL MAIL YOUR MEMBER ID CARD TO THIS ADDRESS.
PROMOTION CODE
EMAIL ADDRESS / USER NAME*

** YOUR EMAIL ADDRESS WILL BE YOUR ACCOUNT USER NAME.
PERSONAL PASSWORD*
ENTER PASSWORD CONFIRM PASSWORD
Terms and Conditions*
- I HEREBY AUTHORIZE SOCIALLITY TO CHARGE MY CREDIT CARD OR DEBIT CARD THE AMOUNT DUE FOR THIS PROGRAM ACCESS ACTIVATION.
- I HEREBY AUTHORIZE SOCIALLITY TO AUTOMATICALLY CHARGE MY CREDIT CARD OR DEBIT CARD THE YEARLY ACCESS FEE. I UNDERSTAND THAT THIS CHARGE WILL AUTOMATICALLY BE MADE UNTIL SUCH A TIME THAT I ELECT TO CANCEL MY ACCESS.
- I HEREBY ACKNOWLEDGE AND UNDERSTAND THAT I MAY CANCEL THE PROGRAM ACCESS AT ANY TIME WITHOUT PENALTY. UPON CANCELING MY ACCESS, SOCIALLITY WILL IMMEDIATELY DISCONTINUE CHARGING THE YEARLY ACCESS FEE.
- I HEREBY ACKNOWLEDGE, AGREE TO, AND ACCEPT THE SOCIALLITY PRIVACY POLICY, THE SOCIALLITY WEBSITE USE TERMS AND CONDITIONS, THE SOCIALLITY ACCESSNOW TERMS AND CONDITIONS, AND THE SOCIALLITY HEALTHCARE COIN TERMS AND CONDITIONS.
- I HEREBY ACKNOWLEDGE THAT I UNDERSTAND THAT NONE OF THE PROGRAMS OR SERVICES ARE AVAILABLE TO ME BY SOCIALLITY ARE INSURANCE PRODUCTS. THE SOCIALLITY ACCESSNOW PROGRAM IS DESIGNED TO HELP MANAGE OUT-OF-POCKET AND SELF-PAY DEDUCTIBLE EXPENSES ARE ARE IN NO WAY TO BE CONSIDERED INSURANCE.

THE DENTEMAX DENTAL SAVINGS PROGRAM IS NOT AVAILABLE IN THE STATES OF AR, CA, CT, DE, FL, HI, IL, IN, KY, LA, MO, MT, NV, OK, OR, RI, SC, SD, TX, UT, WA, AND WV.