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Please complete the following information if you would like to inquire about offering 
American Dental Care to your company.
How did you hear about us?
Company Name
Address
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Zip Code
Phone #
Present Dental Coverage
Number of Employees
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This plan is not insurance. The plan provides discounts at certain health care providers for medical services.
The plan does not make payments directly to the providers of medical services. The plan member is obligated
to pay for all health care services but will receive a discount from those health care providers who have
contracted with the discount plan organization.
 

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