Confirmation Page

APPLICATION CONFIRMATION


Thank You and Welcome! We are proud to offer you individual dental insurance. For over 155 years, Guardian has been providing high-quality insurance products to more than 20 million Americans. Together with our subsidiaries, we're one of the largest dental insurance providers in the nation with over 7 million dental members and over 110,000 dentists in our network. We look forward to providing you with all your dental insurance needs! Below is a summary of your application with instructions on how to remit your payment:


Confirmation Number:
First Name:
Middle Initial:
Last Name:
Email:
Phone:
Address:
City:
State:
Zip:

Plan Name:
Application For:
Coverage Effective Date:
Premium Amount:
Payment Frequency:

Payment Method:
Prior Carrier Policy ID:
Prior Carrier Name:
Prior Carrier Coverage Term Date:
Prior Carrier Phone No:
Associated Broker
Agency:
Broker:
How to Remit Payment: CREDIT CARD If you paid by credit card, your initial payment was taken at the time of this enrollment. All future recurring monthly premiums will be deducted on/or about the 25th of each month, prior to the month of coverage. ACH If you paid by ACH your recurring monthly premium will be deducted on/or about the 25th of each the month, prior to the month of coverage. CHECK or MONEY ORDER If you paid by check, cashier’s check or money order, your monthly payments must be received no later than the 25th of the month prior to coverage. You have chosen to not sign up for credit card or ACH recurring payment and will be responsible for making the monthly premium payment to Guardian each month -- to be received no later than the 1st of the coverage month. Guardian will mail you a monthly invoice for payment submission. Checks and money orders should be written and mailed to: PO BOX 603222 Charlotte, NC 28260-3222 Please review the application information above.If you have any questions or would like to change your payment method, you can do so by logging onto the member site at mydental.guardianlife.com or you can call (866) 569-9900 (toll free). Authorization \| E-Consent \| Fraud Warning \| Important Notices \| Legal Notices and Disclaimers