Ohio EFDA Association Advertising Form

Advertising Packages

Billing and Contact Information

First Name: *

Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

In Memory Of:

Honoree Name:

Send Email acknowledgement to:

Send Postal Mail acknowledgement:

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

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Country:

Dedication Message:

Payment Details

Credit Card eCheck

Routing Number: *

Account Number: *

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Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

Invoice Number:

Purchase Order Number:

Name: *
Reference Number:

You will be charged:

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Supporting the Ohio EFDA Association makes sense!

When you advertise with Ohio's EFDAs you are helping to:

• Ensure a large talent pool of qualified and highly skilled EFDAs

• Give EFDAs a greater voice on public policy

• Provide continuing education and mentorship to EFDAs

• Support the association of a valued member of the dental care delivery team

Advertising with the Ohio EFDA Association is tax deductible as trade or business expenses as allowed by the law.

Benefits of Advertising

• Reach EFDAs, Students, and Dentists

• Recognition on website, at events, and in publications.

• Logo placement on wesbite, at events, and in publications.

For details on packages, please email us at info@ohioefda.org to determine the right package for you.

The Ohio EFDA Association

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount