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	Finally...Affordable alternatives to traditional high-cost dental insurance, vision care, and chiropractic benefits for your entire family.

Apply for Benefits: Family

If you've browsed the rest of the site, by now you see the enormous benefits of becoming a member of Benefactors Plus. In addition to discounts in dental, chiropractic, vision and hearing services, plus all of the other amenities that Benefactors Plus offers, you also have the chance to become involved with the LEAP® System for reorganizing and streamlining your financial goals. There is perhaps no other organization that offers so much value for so little cost.

Applying for membership is both quick and easy. Please fill out the contact form below, including your payment information, and click "SEND APPLICATION". To review our Privacy Statement, click here.

Upon acceptance, you will receive a fulfillment package with provider listings and program updates. After that, you can start using the benefits of the plan immediately. Congratulations on taking your first step toward financial freedom!

Prefer to mail your payment? Just print this page, complete the form, and mail with payment to:
2431 Atlantic Ave., Manasquan, NJ 08736

Learn about our Fee Structure...

Fields noted with a * are required.

* First Name
* Last Name
* Address
* City
* State
* Zip Code
* Contact Phone w/Area Code
* E-Mail
How Did You Hear About Us?
Family Member Names (including applicant)	Birth Dates Year - Month - Day

PAYMENT INFORMATION

Card Number
Name as it appears on card
If billing address is NOT the same as above, please complete the following:
Billing Address
City
State
Zip Code
Comments, Questions or Additional Family Members

By clicking the "SEND APPLICATION" button, you are stating that you have read and agree to our terms and privacy statement.