2500 Louisiana Blvd. NE; Suite 600
Albuquerque, New Mexico 87110
(505) 883-4777 or (800) 999-0963
This Agent Agreement, by and between Delta Dental Plan of New Mexico, Inc. (“Delta Dental”) and
______________________________(“Agent”), is effective on _______________________.
WHEREAS, Delta Dental is a nonprofit healthcare corporation incorporated under the laws of New
Mexico to market, underwrite and administer dental plans of New Mexico-domiciled entities including New
Mexico-domiciled entities with multi-state operations and WHEREAS, Agent is licensed under the laws of
New Mexico to act as such in connection with the solicitation and arrangement of the issuance of health
insurance policies; and, WHEREAS, the parties want Agent to represent Delta Dental within a defined
THEREFORE, based upon their mutual promises contained herein the parties agree as follows:
SECTION 1: APPOINTMENT
1.1 Delta Dental appoints Agent as its nonexclusive Agent, and Agent accepts this appointment subject
to the approval of the New Mexico Division of Insurance. Agent understands and agrees that his or
her appointment shall be as an independent contractor to Delta Dental and not as an employee or
in any other capacity.
1.2 Delta Dental shall file the appointment with the New Mexico Division of Insurance on behalf of
Agent. Agent may be responsible for paying some fees associated with the initial appointment.
Subsequent annual re-appointment fees for Agent may be paid by Delta Dental. Agent shall
provide proof to Delta Dental that said license is active by submitting a copy of current license to
Delta Dental upon request.
SECTION 2: SALES TERRITORY
Agent’s nonexclusive sales territory shall be in the State of New Mexico.
SECTION 3: DUTIES
3.1 Agent shall use its best efforts to solicit applications for Delta Dental products and services; collect
initial premiums and other charges; avoid conflicts of interest, and generally cooperate with