Forms
At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.
Agent Agreement Packet
Agent Agreement Addendum
Form W-9
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Note: You can fill out most of this form on a computer. However, you will need to print it, sign it, and then return a paper or scanned copy to Delta Dental of New Mexico.
Employer Subgroup Information Page and Application Addendum
Individual Authorization Form
ACH Authorization
Claim Form
Mail completed claims to:
Delta Dental of New Mexico
100 Sun Avenue NE, Suite 400
Albuquerque, NM 87109
If the information you are looking for is not available here, contact your Account Manager.