Get started

It's easy to get appointed with us:

1 Download the form packet (choose either New Jersey or Connecticut)
New Jersey Forms (pdf, 27 pages, 540KB)
Connecticut Forms (pdf, 27 pages, 546KB)
2 Fill out the forms (note—all required forms are included in this packet).
3 Print the packet, and then sign and date each form. Please review each page to make sure there are no blank fields!
4 Fax, mail or email the completed packet to:


Delta Dental of New Jersey, Inc
Attn: Commission Department
1639 Route 10
Parsippany, NJ 07054

Email as an attachment

Once we receive and approve your paperwork, we’ll share your unique URL with you; you’ll need this URL to ensure that you receive commissions for the policies you write.

Frequently Asked Questions

Here is an FAQ of common questions about the program, including program details and how to use the custom URL.