Monthly Payment Option

I authorize the Indiana Dental Association, an Indiana non-for-profit corporation, to initiate automated debits to the bank account provided. This authorization includes all adjusting entries, either debit or credit, that may be required.

I agree to pay all such Dues amounts owed and designed by me. If, for any reason, my bank account is revoked, suspended, halted by me or the debit cannot be processed for any other reason, I remain responsible for paying the Dues installment owed directly to IDA on a timely basis. If a debit cannot be processed, IDA is authorized to attempt to initiate the debit again at a later time. If, for any reason, a debit is repeatedly dishonored. IDA is not liable for any losses incurred by reason of any failure in the automated debit process. I am responsible for any fees that may be imposed by bank. If my payment cannot be processed on any two debit dates, IDA may terminate the automated debits by giving me written notice at my address as shown in IDA’s records. My membership shall not be considered in good standing until all past Dues amounts owed are considered current.

I may terminate automated debits by notifying IDA by calling 800-562-5646. The termination will be effective seven (7) business days after the date the notice is received by IDA. Following any termination of automated debits by either IDA or me, I will be responsible for paying my remaining Dues in full, directly to IDA.

No refunds will be provided for canceled memberships. By enrolling in a membership, I understand that a “membership year” spans a calendar year from January through December and not a twelve-month period from the date of enrollment. This authorization shall be governed by and interpreted in accordance with the laws of the State of Indiana, without giving effect to any choice of law rule that would cause the application of the laws of any other jurisdiction to the rights and duties of the parties.

If I elect to enroll in the installment payment program, I understand that for each membership year, defined as January through December: if I enroll prior to January 5 of such membership year, the first debit shall be made on the 15th day of January; if I enroll after January 5 of such membership year, and such date falls on any of first through 5th days of the current month, my first debit will be on the 15th day of the month that I enroll. In any event, subsequent debits shall be made on the 15th day of each succeeding month through December of the membership year. If the scheduled date of a debit falls on a weekend or a legal or business holiday, the debit will occur on the next business day. By enrolling in the Monthly Dues Payment Program, I am thereby agreeing to the Authorization Agreement as detailed above.

If I enroll prior to January 5, each monthly debit shall be in an amount approximately equal to one twelfth (1/12) multiplied by the sum of the total tripartite dues for the membership year to IDA, American Dental Association, my local component society and other recipients designated by me (“Dues”). If I enroll after January 5, the first monthly debit will be the cumulative monthly amount required to bring the monthly payments current and subsequent monthly debits shall be equal to one twelfth (1/12) multiplied by the sum of the total tripartite dues for the membership year to IDA, American Dental Association, my local component society and other recipients designated by me (“Dues”).