877-203-6767
mConsent AR Webniar
Practice Name:
*
Phone:
*
Email:
*
Address:
*
City:
*
State:
*
Zip:
*
Office Manager Name:
*
Doctor / Owner Name:
*
Plan Information:
No Set-up Fee Pricing: 2.79% Processing fee + 20 Cents Transaction Integration with Eaglesoft, Open Dental and Dentrix 1 click SMS and Email (HIPPA Compliant) Attach Invoices 30/60/90 day due reports Simplified Tracking Automated process for dental practice
Pricing Options:
*
Monthly Plan: $99
Annual plan: $998
Add additional screens:
-
+
Setup fee: $199
Monthly: $69 + (
total additional screens
x $25)
Total : $
Contract Details:
If you selected the Annual Plan, you agree to a 12-month commitment. Cancellation requests must be submitted via email to SRS at support@srswebsolutions.com at least 60 days before the contract expiration date. If a timely cancellation request is not received, the contract will automatically renew for a 12-month period . mConsent API must be removed from your practice server by the mConsent support team for the cancellation to be considered final.
By signing this order sheet, you are agreeing to following terms and conditions of SRS Web Solutions Inc: http://srswebsolutions.com/terms-services/
Next Steps:
Finalize payment
Complete order form to specify preferences for account creation
Once your account has been created, you will receive login information
Login to your tv.mconsent.net portal and explore!
If you cancel your mConsent account and decide to come back:
Please contact our sales department at 877-203-6767 ext. 1.
You may be subject to set up and integration fees for some forms.
Authorized name:
*
Authorized Signature:
*
(Draw Signature)
Clear Signature
Date:
I agree with the
Terms and Conditions
of working with SRS Web Solutions
(Your IP Address :
18.97.14.87)
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