2015-2016 Dental Reference Guide

CROWNS

3M PREFABRICATED CROWN ORDER FORM Name___________________________________________________________________ Phone _______________________________ Address ____________________________________________________________________________________________________________ City ____________________________________________________ State_____________ Zip ___________________________ Instructions: This order form is formatted the same as the 3M crown kit drawers to allow for easy ordering. Fill in spaces with the number of refill boxes for each size. If there are two sizes in a space, circle the appropriate number. Refill boxes contain 5 crowns. Fax: 888-681-5088 or call your Dental Health Products Account Manager at 800-626-2163

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