Contact Us Address 100 Tarentum Bridge Rd New Kensington, PA 15068 Phone (800) 814-7809 Email support@dentalsupli.com Refil! Order Request Please enable JavaScript in your browser to complete this form.Full Name *Practice Name *Phone Number *Email *Product SKU *Purchase Timeline *SelectEvery 6 MonthsEvery 3 MonthsEvery 2 MonthsOnce A MonthOnce Every 2 WeeksOnce A WeekProduct SKUPurchase TimelineSelectEvery 6 MonthsEvery 3 MonthsEvery 2 MonthsOnce A MonthOnce Every 2 WeeksOnce A WeekProduct SKUPurchase TimelineSelectEvery 6 MonthsEvery 3 MonthsEvery 2 MonthsOnce A MonthOnce Every 2 WeeksOnce A WeekName on Credit Card *FirstLastCredit Card Number *Security Code *CommentsPurchase Policy Agreement *I AgreeThe first order will be discounted at 15% however, a minimum of 2 purchases must be made per year. The annual cut off date is June 1st of the purchase year. If a purchase is made before June 1st and a second order is not placed by December 15th, a second order will be completed by DentalSupli on December 16th of the purchase year. By selecting the "I Agree" checkbox, you are agreeing to the Purchase Policy Agreement.WebsiteSend