AADOM Plan Implementation - Step 1

Your SmileMore Dental Savings Plan Implementation Starts Here!

Congratulations for starting a Recurring Revenue Revolution for your dental practice. To begin your plan implementation process (which includes a secure enrollment webpage, custom brochure, plan management software, team training videos, and monthly support for your team) please complete the following form. Once submitted you will receive the next step via email or you can continue to the next step in your Members Area.

Practice Name *

Practice Address *

Contact Person Name *

Contact Person Email *

Contact Person Phone *

This Dental Savings Plan is: *

An Annual Plan

A Monthly Plan

Enrollment Fees

Please indicate the fee for each family plan

One Member *

$

Two Members *

$

Three Members *

$

Four Members *

$

Five Members *

$

Six Members *

$

Seven Members *

$

Eight Members *

$

Please Upload Your DSP Procedure Planner from Module 5. File Upload (WORD,EXCEL,PDF) *

Maximum upload size: 134.22MB

Once your FREE monthly support period has ended we will begin your monthly support charges. Please complete the below form so we can establish your future payments.

Please Download and Complete Your Credit Card Authorization Form*

Upload Your Completed Credit Card Authorization Form or email it to info@smilemore.marketing

Maximum upload size: 134.22MB

*The Credit Card Authorization Form is for your monthly software support and enrollment webpage. As part of this promotion, you have received either 2 or 3 months of free support. Your support charges begin 2 or 3 months to the day after your enrollment webpage and custom brochure are complete, based upon the terms of your Plan Implementation when you purchased.

*

By submitting this form I agree to a minimum of 12 months of paid support after my free promotional period has ended.
After 12 billing cycles, my SmileMore Dental Savings Plan will convert to a monthly agreement and can be canceled by providing 30 days notice to SmileMore Marketing.