Credit Card Authorization Form | Dental Assisting Institute | (209) 527-0101
$25 Off Any Course
Simply By Scheduling a Tour! *

Call Us Today!
(209) 527-0101

* Cannot be combined with any other discount including prior student discount. Can be used one time per student.
  • authorize Dental Assisting Institute to charge my Credit Card in the

  • I understand that this payment is non-refundable and non-cancellable.

  • Both sides of Credit Card and both sides of ID Document must be submitted to Dental Assisting Institute

    605 Standiford Avenue, Suite H
    Modesto, CA 95350