ADA Claim Form - Version 2024. Printed Front & Back, 8-1/2" x 11", Laser Form.

• Revised 2024 Version Dental Claim Forms
• 500 Single Sheets for laser printers
• This will be the only form accepted by the American Dental Association for claims effective 1/1/24.
• 100% guaranteed compliance. Meets The American Dental Associations guidelines.
• HIPAA Compliant

FREIGHT CHARGES
ACS always confirms to our customers total amount to be charged including freight costs before order
is processed.

RETURNS
There is a 15 day return policy. Customers have 15 days to return products after they have received them. Products are not returnable after this time. Returns are subject to a restocking fee of 25%. If the return is a result of our error, we will issue a call tag. We grant returns on products only if the product and the packaging are in re-sellable condition. Custom products are not returnable.

SALES TAX
ACS charges sales tax if you are a Texas resident, Texas State Sales Tax will be added at the time your
order is invoiced. If you are tax exempt you must provide a Texas Sales Tax Exemption Certificate.