Get If Paying By Mastercard, Discover, Visa Or American Express, Fill Out Below

Completing the form for payment by credit card is an essential step in managing your dental expenses. This guide will walk you through the process of accurately filling out the necessary fields online to ensure your payment is processed smoothly.

Follow the steps to complete the payment form online:

1. Locate and press the ‘Get Form’ button to retrieve the payment form and open it in your browser.
2. Identify the section labeled 'Check card using for payment.' Select your card type, either MasterCard, Discover, Visa, or American Express, by clicking on the corresponding option.
3. Enter your card number in the designated field. This is typically a 16-digit number located on the front of your credit card.
4. Provide the expiration date of your card in the specified format, usually MM/YYYY.
5. Sign your name in the signature field to authorize the payment. This signature needs to match the one on the card.
6. Fill in the statement date, ensuring it reflects the date you received your bill.
7. Include your address in the address section to confirm your billing information.
8. Indicate the amount you wish to pay, ensuring it matches the total due from your statement.
9. Upon completing all fields, review your entries for accuracy. After verifying, you can save your changes, download a copy of the completed form, print it for your records, or share it as needed.

Complete your payment form online today to ensure prompt processing!