How to apply for Individual Dental Coverage

Your coverage is effective on the first of the month
following the date we receive your application
and premium

The applications will be downloaded in the PDF format (Portable Document Format) by Adobe®. Most computers may already have the Adobe Reader® installed. If you don't, simply go to the link below to download and install on your computer. Once installed, download the required application form and open in the Adobe Reader® and print the form in black ink.

Download a Free Copy of  the Adobe Reader®

Step 1 :

Download the Complete Brochure with application

or

Down the Dental Application

and complete application and bank draft form if applicable

Step 2:

Identify you premium on the Premium Rates Chart

Step 3

Option 1: Mail you check along with your application to our office at -

Make check payable to: World Insurance

Mail to:  James Stafford Insurance Agency
1562 NW Access Rd.
Mount Vernon, TX 75457

Option 2: If you pay your premium by "Bank Draft" or by "Credit Card" you may fax or email your completed application to our office.

The fax number is 1-888-475-4437

The email address is jcstafford@verizon.net
(if you email application, the application must contain your signature)

If you have questions, please give us a call
DFW Metroplex (903) 537-2819
or Toll Free 1-888-869-4904