Please enable JavaScript in your browser to complete this form.Name: * have recent obligation Address: *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePractice Name: *Contact Name: *Phone *Fax:Email: *Current Equipment:Account Number:Are you an AIDA-Align Member? *YesNoDental Account Rep:Please Upload Your Current Processing Statement Click or drag a file to this area to upload. Secure Upload: Your processing statement is encrypted and securely transmitted using SSL encryption provided by Let's Encrypt. All uploaded documents are stored securely and only accessible to authorized Dental Strategic personnel.I have included my most recent merchant services statement for my free, no obligation comparison. *I have included my most recent merchant services statement for my free, no obligation comparison.Let’s move forward with the application. *Let’s move forward with the application.Submit