Applying is Easy

 

Instructions:

  1. Print, complete and sign the application on the next page for yourself and/or your spouse and children.
  2. Print, complete and sign the membership premium payment authorization form.

  1. Write "VOID" across one of your blank checks.
  2. Your only other payment option is to pay premiums annually.  If that is your wish, just omit steps 2 and 3 and include a note requesting annual billings.
  3. Enclose the above items in an envelope and mail to:

DPMA Life Insurance Plan
c/o Harvey Watt & Co.
P.O. Box 20787
Atlanta, GA 30320-9805

Note: Do not email or fax information.  We must have your original signatures.  Call us at 1-800-241-6103 if you have any questions.