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Payment Authorization Form for Full-Day Team Workshop

Please complete the information below to approve the use of your credit card for payment of the full-day team training workshop. Please note, this full-day workshop will take place at Identity Dental Marketing's office in Bloomingdale, IL. Address will be provided prior to workshop. Investment of $1,500 per attendee paid to Identity Dental Marketing does not include travel or lodging. 

I authorize Identity Dental Marketing to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this form.