Register your shop

To apply for BettyNet, the DentBetty Network, please complete the following application. All fields are required unless otherwise specified. If you have any questions, please don't hesitate to contact us.

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About Your Shop

Shop Name*

The shop name that will be shown to customers.

Contact Person*

This is the person at your shop we can contact if we have questions.

Brief Shop Description*

One or two sentences about your shop and services that you wish to highlight to prospective customers.

Detailed Shop Description for your Profile (Optional)

A more extensive profile for the shop directory. You may want to cut and paste text from your website if you already have one. If you prefer, this may be filled out later (in your "Edit Shop Info" section), so it is not required to fill it in right now. Display of this description in the general Public Directory is for PRO Accounts only.

In Business Since Year (Optional)

What year did your business open? Example: 1993

Shop Website (Optional)

The shop's web page.

Link to Promotional Video (Optional)

If you have a promotional video on web (e.g. YouTube, Truveo, Metacafe, etc.) what is the link?

Photos of Your Shop (Optional but strongly encouraged)

Include interior and exterior shots of the shop.

Location, Phone, Email

Street Address*

City*

State* Zip*

Main Shop Phone Number (Including area code)*

This is the phone number customers and we will use to contact you.

Shop Email Address*

This is your email address that customers will write to and also where you'll receive DentBetty alerts.

It is easy to unsubscribe to DentBetty or go on "Vacation Mode" if you wish, and we respect your privacy, but for the system to work it is necessary that you list the shop's email address that you check daily.

Shop Email Address (Confirm)*

Please type your email again.

Additional Comments for DentBetty Administrators (Optional)

Any instructions or contact preferences that you'd like DentBetty to know about?

Hours

Select your shop's business hours, or choose "Closed."


Sun	Or	Closed Sundays
Mon		Closed Mondays
Tue		Closed Tuesdays
Wed		Closed Wednesdays
Thu		Closed Thursdays
Fri		Closed Fridays
Sat		Closed Saturdays

Certifications & Features

Shop Certifications

Please list any important certifications and specialized training your shop has.
Example: ASE, I-CAR®, BMW Certified.

If you listed certifications, please upload photos of those certifications:

Is your shop a member of AAA-approved shops?
	Yes
	No

Which insurance companies do you work with?
	All
	Primarily these companies:

Are you a member of a DRP (Direct Repair Program)?
	Yes, these programs:
	No

Do you take desk assignments?
	Yes
	No

Other Information

Are you already listed in the DentBetty Shop Directory?

(Did you recently sign up for the Shop Directory?)

Yes. I'm already in your directory. Please convert my entry to a BettyNet shop.
No. Please include me.

How did you hear about us? (Optional)

Terms of Use

Ready to submit to the The Betty? Please double-check the information above. We will review your information in this application and contact you by phone or email within about two business days.