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We accept all major credit cards. Call us today at
1-800-522-4636.


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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  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


  Clear ImageĀ® Aligners Rx
  Functional Appliance Rx
  GuardianĀ® Invisible Retainers Rx
  Herbst Appliance Rx
  Indirect Bonding Rx
  Metal Appliance Rx
  Positioner Appliance Rx
  Retainer Appliance Rx (includes Sagittal and Schwarz)
  Splint Appliance Rx


DVDs ($12 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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