In consideration of Peterson Dental Laboratory, Inc. extending credit to Customer, Customer agrees to the following terms and conditions. These terms and conditions control over any conflicting provisions contained in any contracts, documents, purchase orders, confirmations or the like from the Customer. To ensure understanding and acceptance Peterson Dental Laboratory’s terms and conditions, we require all new accounts to complete and sign this form and forward it to our accounts receivable department.

If we do not receive this response card, any new cases will be billed on a COD basis until the credit agreement is received.

1. Payment: Customer shall pay the fee and all other charges associated with the case 30 after statement. A $25 late payment and/or interest charge of 2% per month shall be added to all amounts not paid when due. Buyer shall pay all costs incurred by Peterson Dental Laboratory in collecting any amount due, including all reasonable attorneys’ fees and a $30.00 handling charge for any returned checks. The undersigned agrees that this agreement is made in the State of Florida and that Palm Beach County, Florida is a proper venue for any action to collect money owed to Peterson Dental Laboratory, Inc. by the Customer.
2. Nonconforming Goods: Any claim that any goods provided by Peterson Dental Laboratory, Inc. to Customer do not conform to the description on the invoice will not be credited unless Customer gives written notice to Peterson Dental Laboratory within 30 days after the Customer’s receipt of the invoice. Peterson Dental Laboratory, Inc. will repair, or remake work invoiced no more than 12 months ago to the Customer’s satisfaction and the charges will be agreed upon at the time of the repair/remake.
3. Principle Practice: Principal practice and or owner of group, will be ultimately responsible for all invoices incurred from any affiliate dentist working for the principle practice group. If practice does not wish to be responsible for affiliate dentist, then a separate Credit Agreement and Warranty & Return Policy will need to be completed before account will be issued credit. The account will remain on COD status until forms received by lab.
4. Authorization to obtain Credit Information: Customer expressly authorizes Peterson Dental Laboratory, Inc. to seek and obtain credit information from all sources, including but not limited to, all credit bureaus and credit reporting agencies.

To simplify the management of your account we offer payment by Visa, Master Card or American Express.

To take advantage of this payment option, we must have authorization to process the charge. An authorization form is at the bottom of the page.

Your credit card can be processed by either option:

     1.The account balance can automatically be billed to the credit card on file the day the statement is processed.

     2.Receive your statement the first of each month and if there are not any discrepancies your account will automatically be billed to the card on file on the fifth of the month.

Please fill out the pre-authorization form to utilize this method of payment. Please choose which processing option works best for you. Feel free to call our Accounts Receivable Department with questions or for additional information