Dental Health 2019 Catalog

Supply Order Form

Order, Pricing and Product Questions: Toll Free: 800-626-2163 Toll Free Fax: 888-681-5088 Account #: _____________________________________

Date _________________________________ Check Here If First Order Ordered By ____________________________

Office Name ______________________________________ Phone (_______) _______________________________ Fax Number: ____________________________________________________________________________________ Address_________________________________________________________________________________________ City __________________________________________________________ State ___________ Zip ______________ Salesperson _____________________________________________________________________________________

Payment Method Choose One:

Credit Card

Bill My Account

Please call the Dental Health Products, Inc. Billing Department with your credit card information. (800-626-2163)

Check-by-Phone

Qty Item#

Size/Color Product Name/Description Unit Price Extended Price

Check-by-Phone Has Replaced C.O.D.'s Our customers are enthusiastic about our Check-by-Phone service. Check- by-Phone is faster than C.O.D. and saves you the $10.00 or $10.50 fee. To use Check-by-Phone just tell your Account Manager or Customer Service Representative your check information. It’s that easy! No C.O.D., no extra charge; it’s all taken care of!

Sub Total: Shipping: Fuel Surcharge: {This fuel charge will be monitored an adjusted on a regular basis.) Handling Fee: TOTAL:

$0.00 TBD