ADVANCED STANDING PROGRAM FOR INTERNATIONAL DENTISTS

Payment Portal

Make a Payment with a Credit Card or a Debit Card

                 

Instructions: Please provide the following information to ensure that your payment is properly credited:

Payment Information

* Required Fields

Applicant First Name:*


Applicant Last Name: *


Email Address:: *


Payment Purpose:: *


Payment Amount: *
$ (US Dollars) (Do not enter $ sign)


Additional Comments:


Contact Information

* Required Fields

Your Name (Payor):*


Your Contact Phone Number: *


Email Address: *


Instructions: Click on the Submit Button below to be taken to our external payment processor website (Touchnet) to complete your Credit Card Payment: