Diversified Dental Sales - Handpiece Mailer

Where should we send our FREE Handpiece Repair Mailer Kit:

*First Name:




Your FREE Handpiece Repair Mailer Kit includes the following:

	1. Two Part Carbon Repair Form Fill out the form and keep the yellow copy for your records.
	2. Box with UPS Pre-Paid Label A pre-paid UPS return label is included in your Handpiece Repair Mailer Kit.

*Last Name:

Title:

(DDS, RDH, etc.)

*Business Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Phone:

*Fax:

*E-Mail:

*Number of Mailers:

Message: