PAYMENT PROGRAM
ONE-TIME
INCENTIVE for New Enrollees
To assist our members with making it easier to maintain membership
and to increase participation in PDA ’ s monthly dues payment program ( eDues ), PDA is offering a one-time $ 50 incentive to new eDues enrollees .
The program will automatically debit your membership dues from your designated credit card in 12 equal installments from January through December of the current year , 2022 . You will be notified of your monthly debit amount after PDA receives your completed eDues enrollment form . The eDues program provides you with an incremental , hassle free and automatic method for maintaining membership .
FOR 2022 , PDA IS OFFERING A ONE-TIME $ 50 INCENTIVE FOR NEW EDUES ENROLLEES . CREDIT / DEBIT CARD eDUES ENROLLMENT AGREEMENT
PDA IS PLEASED TO ANNOUNCE A CREDIT / DEBIT CARD OPTION FOR THE eDUES PROGRAM . The program will automatically debit your membership dues from your designated card in 12 equal installments from January through December of the current year , 2022 . Members can sign up to participate in electronic payments for the current dues year in any month except December . The eDues program provides an incremental , hassle free method for maintaining membership .
I ( we ) hereby authorize the Pennsylvania Dental Association to charge entries to the credit or debit card indicated below .
□ Visa
□ MasterCard
□ American Express
□ Discover
Indicate Personal or Corporate credit card :
□ Personal
□ Corporate
Credit Card Number : Credit Card Expiration Date :
Debit Card Number : Debit Card Expiration Date :
PLEASE RETAIN A COPY OF THIS FORM FOR YOUR RECORDS .
This authority is to remain in full force and effect until the Pennsylvania Dental Association has received written notification from me ( or either of us ) of its termination in such time and manner as to afford the Pennsylvania Dental Association and FINANCIAL INSTITUTION a reasonable opportunity to act on it . PDA will issue a refund to members who withdraw from the eDues program and want to terminate membership if written notice is received before March 31 . After the March 31 deadline , any unallocated dues already collected on the member ’ s behalf will be recognized as PDA dues revenue .
( Print Individual Name ) ( Signature )
( ADA Number ) ( Date ) PLEASE FAX COMPLETED ENROLLMENT AGREEMENT TO PDA AT ( 717 ) 232-7169 .
BANK ACCOUNT ( ACH ) eDUES ENROLLMENT AGREEMENT
PDA WILL CONTINUE TO OFFER THE eDUES PROGRAM FOR BANK ACCOUNTS . The program will automatically debit your membership dues from your designated bank account in 12 equal installments from January through December of the current year , 2022 . Members can sign up to participate in electronic payments for the current dues year in any month except December . The eDues program provides an incremental , hassle free method for maintaining membership .
I ( we ) hereby authorize the Pennsylvania Dental Association to debit entries to the account and financial institution indicated below .
Indicate Personal or Corporate Account : □ Personal □ Corporate
( Financial Institution Name ) ( Routing Number ) ( Account Number ) Type of Account : ____ Checking ____ Savings
PLEASE ATTACH A COPY OF A VOIDED CHECK TO THE BANK ACCOUNT DEBIT ENROLLMENT FORM . PLEASE RETAIN A COPY OF THIS FORM FOR YOUR RECORDS .
This authority is to remain in full force and effect until the Pennsylvania Dental Association has received written notification from me ( or either of us ) of its termination in such time and manner as to afford the Pennsylvania Dental Association and FINANCIAL INSTITUTION a reasonable opportunity to act on it . PDA will issue a refund to members who withdraw from the eDues program and want to terminate membership if written notice is received before March 31 . After the March 31 deadline , any unallocated dues already collected on the member ’ s behalf will be recognized as PDA dues revenue .
( Print Individual Name ) ( Signature )
( ADA Number ) ( Date ) PLEASE FAX COMPLETED ENROLLMENT AGREEMENT TO PDA AT ( 717 ) 232-7169 .
Following are a few reasons why members enroll in the eDues program :
Maintaining membership with incremental payments eliminates the large annual payment that may be a burden on the bank account or credit card .
Enrollment reduces the need to be on the lookout for an annual dues invoice . Essentially members can set it and forget it .
Receive ongoing membership benefits while paying dues on a monthly basis .
NOVEMBER / DECEMBER 2021 | PENNSYLVANIA DENTAL JOURNAL 31