Dental Office Name

National Physician ID No. (required for US doctors)

Dental Office Contact

Address

City

State

Zip / Postal Code

Country

United StatesCanada

Dental Office Phone No.

Invoice Number

Date of Purchase

Other - For ALL Promotions Not Displayed above, please reference in the box below:

Second Half 2023 Clinician and Meeting Specials expire December 31, 2023.

To qualify for free goods on individual promotions, full quantity must be purchased at one time. Eligibility is restricted to the United States and Canada (excludes US territories). May not be combined with other COLTENE promotions. Submit dealer invoice with promotion code by January 31, 2024, to qualify for redemption. Invoices with back ordered product will not be honored; orders must be shipped in full.