Spirit Dental enrollment forms have been provided if you prefer to print and mail your enrollment information.

Please click on the form that fits your requirements.

For Individuals and Seniors living in any other state click on this Enrollment Form

For Individuals and Seniors living in Connecticut click on this Enrollment Form

For Individuals and Seniors living in: Florida click on this Enrollment Form

For Individuals and Seniors living in Maine click on this Enrollment Form

For Individuals and Seniors living in Minnesota click on this Enrollment Form

For Individuals and Seniors living in: Maryland click on this Enrollment Form

For Individuals and Seniors living in: New Hampshire click on this Enrollment Form

For Individuals and Seniors living in: New York click on this Enrollment Form

For Individuals and Seniors living in South Dakota click on this Enrollment Form

For Individuals and Seniors living in Vermont click on this Enrollment Form

For Indemnity Only, for Individuals and Seniors living in AK, ID, IL, ME, NJ, or VA  use this Enrollment Form

After you complete your enrollment form, mail it to:

Direct Benefits, Inc.
325 Cedar Street, Suite 800
Saint Paul, Minnesota 55101

Fax your enrollment form to:
1-651-649-3502

Or, email it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Questions? Please feel free to contact us at any time.