SunshinePay Onboarding Form

TXT2PAY Onboarding Form

Fill out this form and let the office know that the SunshinePay team will call them within 24-48 hours to set up their TXT2PAY account.
Section 1:

Dental Practice Information
Practice Name*
Dentist's Name*

First NameLast Name
Point of Contact's Name (if not the dentist)

First NameLast Name
Office Phone*
Email*
Practice Website
Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this office signed up for eAssist's patient billing service?

YesNo

TXT2PAY Onboarding Form