Membership Checkout - Colonial Dental Plan

You have selected the Plainville Dental Group membership plan.

$359 per extra member ($40 discount)

For each member, the plan includes:

The price for membership is $399.00 now.

Membership expires after 1 Year.

Username

Password

Confirm Password

First Name

Last Name

Email Address

Confirm Email Address

Date of Birth *

Full Name LEAVE THIS BLANK

Number of Additional Family Members (Not Primary Member)

Enter a number from 1 to 10 for the number of additional family members you’d like to add to the account at a discounted price per extra member.

Card Number

Expiration Date

CVC

Discount Code