Set Up Recurring Payments

Setting up recurring payments for monthly fees.

If you plan on charging a monthly, quarterly, or annual fee to participating patients, then you need a simple and secure way to track and charge those fees. The Dental Cooperative has you covered. Easily set up and charge monthly fees for your MyHappMouth program and rest soundly knowing the information is securely stored. Complete the form below and our MyHappyMouth director will contact you to get set up.

REQUEST TO SET UP RECURRING PAYMENTS

*required

Practice Information:

PRACTICE NAME*

NAME OF PRIMARY DENTIST*

NAME OF EMPLOYEE RESPONSIBLE FOR YOUR MYHAPPYMOUTH PROGRAM*

EMAIL OF EMPLOYEE RESPONSIBLE FOR YOUR MYHAPPYMOUTH PROGRAM*

COOPERATIVE ACCOUNT# (Found on Invoice. Optional)

Tell us a little more:

PLEASE LIST THE GROUP ID#'S FOR THE MYHAPPYMOUTH PROGRAMS YOU WOULD LIKE TO USE RECURRING PAYMENTS:

ARE YOU CURRENTLY USING DENTAL COOPERATIVE MERCHANT SERVICES?*

Great! You are one step closer to offering recurring payments. We will give you a call to talk about how we can help you organize and best use this feature.

Ok. You are going to need to get set up to offer recurring payments with your program. It's easy to do and we have the lowest processing rates available. We will give you a call to help get you set up with recurring payments.

WHEN IS A GOOD DAY AND TIME TO CALL YOU ABOUT RECURRING PAYMENTS?

HOW ELSE CAN WE HELP YOU WITH RECURRING PAYMENTS.

Once submitted, we will contact you shortly.