Dental Health 2016 Catalog

3M PREFABRICATED CROWN ORDER FORM

Name___________________________________________________________________

Phone _______________________________

Address ____________________________________________________________________________________________________________

City ____________________________________________________ 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. State_____________

Fax: 888-681-5088 or call your Dental Health Products Account Manager at 800-626-2163

CROWNS

3M Stainless Steel Primary Molar __________Set

3M Stainless Steel Permanent Molar __________Set

3M Unitek ™ Stainless Steel Primary Molar __________Set

3M Unitek ™ Stainless Steel Permanent Molar __________Set

3M Unitek ™ Stainless Steel Primary Anterior __________Set

3M Unitek ™ Stainless Steel Bicuspid __________Set

202 Having trouble locating a product? Visit us at www.dhpionline.com to shop from our full dental supply online store.