#1: Sales Representative Name
#2: Email of sales representive:
#3: Name of Doctor
#4: New Client: Yes No
#5: Shipping Address of Doctor
#6: Doctor's Email
#7: Phone
#8: Method of Payment
Cash / 15%
#9: Specials or notes


This is a new order
This is a continuation of an order

Place your general order here (see codes below):


Codes:

  • BUBBLE 6% HP, 8 unit/2 ml - Item #32650E (BLACK OR WHITE)
  • BUBBLE 10% CP, 8 unit/2 ml - Item #32651E (BLACK OR WHITE)
  • BUBBLE 16% CP, 8 unit/2 ml - Item #32652E (BLACK OR WHITE)
  • BUBBLE 6% HP, 12 unit/2 ml - Item #32629E (BLACK OR WHITE)
  • BUBBLE 10% CP, 12 unit/2 ml - Item #32635E (BLACK OR WHITE)
  • BUBBLE 16% CP, 12 unit/2 ml - Item #32636E (BLACK OR WHITE)
  • BUBBLE REFILL 10% CP, 4 unit/2 ml - Item #32639E
  • BUBBLE REFILL 16% CP, 4 unit/2 ml - Item #32640E

  • SYRINGE 10%, 4 unit/3 ml - Item #32641E
  • SYRINGE 16%, 4 unit/3 ml - Item #32642E
  • SYRINGE 22%, 4 unit/3 ml - Item #32643E
  • SYRINGE 10%, 9 unit/3 ml - Item #32656E
  • SYRINGE 16%, 9 unit/3 ml - Item #32657E
  • SYRINGE 22%, 9 unit/3 ml - Item #32658E


Daily Communications :

Daily Communications

A COPY WILL BE SENT TO YOU

If you experience any difficulty with this system, please email us directly your information here

 

     For a complete information packet, contact Dr. Tracy Kemble at tracyk@fea.net