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New Account

Practice Ship to Address

Doctor 1:

Doctor 2:

Billing Information

Authorization to Order Implant Parts (Implants excluded) and drop ship to NDX nSequence

Payment information

The NDX nSequence Customer Service Department will reach out to you requesting credit card information. Cases will not start without having a current payment option on file. Declined payments will delay your case shipments. We do not offer Net 30 on any accounts except accounts with specific DSOs under an NDX contract. Cancellation fees will be applied according to the cancellation policy listed on RX submission forms. Cases will be charged in full upon shipment. Invoices and credit card receipts will be emailed to the billing e-mail address on file. By submitting this New Account form, I am authorizing NDX nSequence to open a new account, order implant parts on my Implant Vendor account, and charge my credit card accordingly. I will be given the opportunity to approve my case before any parts are ordered.