Payment authorization form

2.5% processing fee is automatically added for credit card payments. There is no additional charge for payments made via Zelle or credit card in person. Credit card fees are applied directly by the processing company
 

PAY WITH ZELLE
Please send the required amount to Zelle on FullertonDentalpt@gmail.com 

OR CREDIT CARD

Credit Card Authorization Form

Please add your name in the form below exactly as it appears on your ID

hereby authorize the office of Eric Meyer DDS, Inc. to charge my credit card. This authorization will remain in effect until I have rescinded it in writing and in such time as to afford you a reasonable opportunity to act on

Practice Name: Fullerton Dental Assistant School
Office Number: (714) 882-5518
Fax Number: (714)879-0754

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