Please fill out and print the form below. You can mail the order form to us at the address at the bottom of this page, or fax it to us at 732-295-1729

Qty/Doz.


Item#


Description

Pricing

6 Dozen

12 Dozen

38383

Soft/Adult

.008” DUPONT TYNEX® nylon, 5 row - 53 tuft

$80.00

$140.00

38384

Gentle/Adult

.006” DUPONT TYNEX® nylon, 5 row - 53 tuft

$80.00

$140.00

38385

Soft/Compact

.008” DUPONT TYNEX® nylon, 5 row - 38 tuft

$80.00

$140.00

38386

Gentle/Compact

.006” DUPONT TYNEX® nylon, 5 row - 38 tuft

$80.00

$140.00

30100

Patient instructions
and convenient re-order form

No Charge

Introductory Offer    

     3 Dozen $50.00

This “special offer” is being made available to introduce you to the Improve® Toothbrush so that your office staff and selected paitients.... can expierence the difference!

Imprinting Information

  1. Imprinting Cost - $10/Gross (Per Style)
  2. All imprint orders must be prepaid.
  3. Shipping time - Approx. 2 weeks.
  4. 28 character maximum

Name

 

 

Address 1

Address 2

City

 State

Zip

Office Phone

Fax

Payment Method:  Master Card Visa  Discover  Am-Ex

Card #

Exp. Date

 

Sec. Code

Signature
 



______________________________________

Date

Home