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Enter your details below, to redeem your free goods.
Entrez vos coordonnées ci-dessous, afin de racheter vos produits gratuitement.
Name / Nom
*
Address / Adresse
*
Country / Pays
*
USA
Canada
City / Ville
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Nova Scotia
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Province
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip/Postal code/Code Postal
*
Dental Office Phone No.
Dental Office Téléphone No.
*
National Physician ID No.
ID national des médecins No.
Specialty/Spécialité
*
General Practitioner/Médecin généraliste
Pediatric Dentist/Dentiste Pédiatrique
Oral Surgeon/Chirurgien dentiste
Periodontic Dentist/Dentiste Parodontie
Prosthodontic Dentist/Dentiste Prosthodontic
Orthodontic Dentist/Dentiste orthodontique
Other/Autre
Email
*
Invoice Number
Numéro de facture
*
SDI Authorized Dealers
SDI Concessionnaires Autorisé
*
Am-Touch
AMI Dental
Arnold Dental
Atlanta Dental
Benco Dental
Bridgerland Dental
Burkhart Dental
Carolina Dental
Central Dental
Darby Dental
Dart Dental
Davis Dental Supply
DC Dental
Dental Health Products
Dental City
Elbee
Freud Dental
Goetze Dental
Henry Schein Dental
Holt Dental supply
Interguide
Jahn Dental Supply
Johnson & Lund
Lonestar Dental
Mel’s Dental
Midway Dental
Midwest Dental
M & S Dental
Nashville Dental
OC 1
Parkway Dental
Patterson Dental
Pearson Dental Supply
Safco Dental Supply
Sinclair
Sky Dental
Tri county Dental
Tri State Dental
Valley Dental Supply
Williams Dental
Young’s Dental Inc
Date of Purchase
Date d'achat
*
+
Upload a copy of your invoice here
Télécharger une copie de votre facture ici
*
🛈
Specials 1st Quarter 2016 - USA
*
Riva = Buy 2 Get 1
Riva = Buy 4 Get 1 radii-cal
Aura Refills = Buy 2 Get 1 or 1 Master Complet Kit
Riva Bond LC, Stae, Go! = Buy 2 Get 1
Specials 2nd Quarter 2016 - USA
*
Pola Mini and 10 syr kit = Buy 5 Get 1 or Buy 10 Get 3
Pola Office + = Buy 2 Get 1
Pola Mini = Buy 20 Get 1 Pola Dispenser kit
Aura MC Kit = Buy 1 Get any 1 refill
seT PP = Buy 2 Get 1
Specials 1st Quarter 2016 - Canada /
Promotions 1er trimestre 2016 - Canada
*
Permite, Gs-80, Lojic+ = Achetez 3, Obtenez 1
Aura Refills = Buy 6 Get 1
Aura Recharges = Achetez 3, Obtenez 1 kit introduction principal d’Aura - compules
All adhesives, riva & points products = Buy 2 Get 1
Tous adhesifs, riva et points des produits = Achetez 2, Obtenez 1
Specials 2nd Quarter 2016 - Canada /
Promotions 2e trimestre 2016 - Canada
*
Pola all products = Buy 3 Get 1
Any Composite refills = Buy 3 Get 1
Aura Refills = Buy 6 Get 1 Master Intro Complet Kit
Ultramat 2 = Only $599
Promo Code (if applicable)
Please provide details of the specials for free goods (eg: Permite, Gs-80, Lojic+ = Buy 3 Get 1)
S'il vous plaît fournir des détails sur les spéciaux pour les marchandises gratuites (par exemple: Permite, Gs-80, Lojic+ = Achetez 3, Obtenez 1)
Dental Office Name/
Nom cabinet dentaire
Dental Office Contact/
Contactez cabinet dentaire
Please contact me for future SDI promotions /
S'il vous plaît me contacter pour de futures promotions SDI
*
Yes / Oui
No / Non