Overview
Get Started
What To Send Us
Packaging Models
Shipping To Us
Supply Request Form
Turnaround Times
FAQs


Supply Request Form

Please complete the following form and then click the "Submit Request" button that appears below to forward your request to a customer service representative.

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Customer Information


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Email Address:


  Please check this box if you are a new customer.
(New customers will receive an Information Kit.)


Mailing Labels


  USPS Prepaid Mailing Labels


Packaging Materials


  Bubble Wrap
  Boxes - Holds 1-2 Cases
  Boxes - Holds 3-4 Cases


Appliance Information


  Color Guide
  Price List


Rx Sheets


  Herbst Rx
  Metal Rx
  Retainer Rx (includes Sagittal and Schwarz)
  Splint/Sleep Appliance Rx
  Indirect Bonding Rx
  Clear Image Aligner Rx
  Functional Rx


DVDs ($10 each plus shipping/handling)


  Banded Herbst - Dr. Rogers
  Crown Herbst - Dr. Davis
  Indirect Bonding - Dr. Dischinger


CDs ($25 plus shipping/handling)


  Appliance Reference Manual


General


  Newsletters and General Appliance Information


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4905 Hammond Industrial Drive, Suite J
Cumming, Georgia 30041

Phone: 678-513-4408     Toll Free: 1-800-522-4636
Fax: 678-513-7345
Quick Links


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  Download Rx Sheets

  Ask a Technical Question

  Print a Mailing Label
  Order Products

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  FAQs

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Testimonials

"Clear Image Aligners are the perfect solution in our practice for those in-between cases when you need to tweak one to six anteriors and Invisalign would be overkill. Our patients love that we have an invisible solution for their alignment..."

View More Testimonials