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item# RFLCA - Smile Protection Plan - Payment Installment Invoice

item# RFLCA - Smile Protection Plan - Payment Installment Invoice

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We look forward to providing you high quality replacement retainers anytime you need or want one. This membership will entitle you to a 3D intraoral scan/photo that will be stored in our cloud and full access to affordable high quality retainer delivered to your mailbox.

This is an invoice of the monthly payment plan installment you chose when enrolling with Retainers for Life. If you have any questions or concerns regarding your Smile Protection Plan, please contact our customer service at [email protected] or by calling (850-735-4968)

Here is a copy of the Retainers For Life® Terms & Conditions as it pertains to your membership and the payment plan process.

Let's customize your protection plan: PATIENT NAME (please give us the name of the person who will be wearing the retainer) *

What is the date of birth of the person wearing the retainer? *

Member ID

This is installment number *

What is the name of your orthodontist? *

Monthly Payment Amount Select all that apply Payment Plan (+ CA$95.83) Payment Plan (+ CA$191.98)

Is your orthodontist still moving your teeth? If unsure, please contact our customer service team. Select all that apply Yes No

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item# RFLCA - Smile Protection Plan - Payment Installment Invoice

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