AllPro On Line Order Form for Disposable Prophy Angles with Pointed Polishers

AllPro On Line Order Forms

All-Dri™ Cotton Pads

All-Wipe™ Instrument Cleaner

Regular Disposable Prophy Angles with
» Prophy Cups
» Brushes
» Pointed Polishers

ProphEase™ Disposable Prophy Angles with
» Prophy Cups
» Brushes

Floss

Interdental Travel Brushes

Non-Latex Prophy Cups
» Latch Mandrel
» Screw Type
» Snap-On

Pedo Products

Pro-Paste™ Prophy Paste

Prophy Brushes
» Screw Type
» Snap-On
» Metal, Screw Type

Protect-A-Lens Protective Eyewear

Disposable Prophy Angle with Pointed Polisher
On Line Order Form
Available in Boxes of 100 and 500.

Indicate how many of each you wish to order in the "Qty" column. The total amount of your order will be calculated automatically. When you are ready to submit your order, click on the Make Purchase button.

Qty	Part #	Description	Price	Total
	808	Disposable Prophy Angle with Soft Green, Pointed Polisher Dispenser Box of 100	$ 60.00
	808-R	Disposable Prophy Angle with Soft Green, Pointed Polisher Dispenser Box of 500	$ 283.00
			GRAND TOTAL:

Name of dental office, school or dealer

Ordered by

Phone Number

E-mail Address

Ship to Address

Bill to Address

Dealer Name (order cannot be placed unless Dealer designated)

(Please call AllPro at 1-800-243-2285 if you need the name of a dealer)

Dealer Purchase Order Number