Best Card Online Payments

Fill out the form below to make a contribution to the
Future Focus for Dental Leadership
$80 monthly plan
$84 monthly plan
$100 monthly plan

Recurring Information

You will be charged $80.00 on day 15th of every month.

Charges begin on the next applicable future date.

Billing Information

Cardholder first name *

Cardholder last name *

Billing Address *

Billing City *

Billing State/Province

Billing State *

Billing Zip *

Phone number

Member Name

Today's payment amount *

Cancellation Policy +

The business maintains the right to, if necessary, initiate adjustments for any transactions credited/debited in error. Should cardholder wish to amend or cancel payment plan detailed below, they must submit written notice at least 10 days before payment date and understand that they are still liable for balance owed for services/products rendered.

I guarantee that I am the legal cardholder for this credit card, that I am legally authorized to enter into this billing agreement.

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