Customer Registration

To request a customer account, please complete the registration form. We will contact you with your login credentials, upon processing your registration request. Please allow 48-hours for registration requests to be processed.

Conditions

All returns require prior authorization / RMA number assigned. Returned goods may be subjected to a 15%
restocking fee.
For your protection, any goods used in the mouth, that have had the packaging opened, may not be
returned for credit. If item is not functioning it will be repaired or replaced as per manufacturer’s warranty.

For questions regarding registration, please call 1-800-847-3160

Customer Registration

Legal Name of Business(Required)

Date Business Commenced(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Email Address(Required)

Phone(Required)

Fax

Would you like to receive invoices / statements electronically?(Required)

Yes

Would you like to receive promotional emails?(Required)

Yes

Customer Registration

Customer Registration

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