Special Enrollment Form



Special Enrollment runs from January 16, 2022 - October 31, 2022.  Enrollments completed by the 15th of the month will take effect on the first day of the following month.  We will offer our consultations during this time period with limited evening and weekend appointment times.


Once your information has been submitted, you will be contacted by the end of the following business day to schedule your appointment.   Your credit card payment will not be processed until your appointment has been scheduled.  If you will be mailing in a check, we will contact you to schedule your appointment time once the check is received.  We will not cash the check until the appointment has been made.  


IMPORTANT: You must click the Pay Online button to finish payment and then  come back to this form and hit the green submit button at the bottom to complete your submission. 

Broker Disclosure and Transparency:

Carriers represented may or may not provide commissions to brokers for the placement of business.  If applicable, commissions are built in to the premiums quoted.  Premiums do not change if the client utilizes the services of a broker or enrolls in a plan directly through the Marketplace Exchange.  This broker charges a consultation fee and will also accept any commissions payable by a carrier.  Client has the right to request copies of carrier’s commission at any time.  Broker will provide such information within 10 business days of request.  Client can view the Denny & Associates, Inc. Notice of Privacy Practices on our website at www.dtdinsurance.com.  Broker will provide a paper copy immediately upon request.


Denny & Associates Inc