Order Form
* Fields required to submit this form
Ship To
(if different than previous address)
Contact Name *
Contact Name
Company Name *
Company Name
Street Address *
Street Address
City *
City
Province / Postal Code - State / Zip Code *
Province / Postal Code - State / Zip Code
E-mail Address *
Contact Phone Number *
Contact Phone Number
Comments
How To Ship
Next Day
2nd Day
3rd Day
Ground
Printable Order Form
Payment Method
Printable Brochure
Credit Card
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Free Acrobat Reader
To Order: Fill in the fields above and the quantities required in the appropriate shade boxes below, then click the Submit button.
Moulds
Shade Numbers
10
11
12
13
15
17
20
21
22
23
24
26
27
31
32
39
40
41
Upper Anterior
385
n/a
390
415
n/a
419
423
425
n/a
426
n/a
432
n/a
436
438
447
448
451
452
456
n/a
458
460
468
470
n/a
475
n/a
480
n/a
482
485
490
501
n/a
503
520
n/a
Lower & Upper Posterior 0 Degree
K1-U
K1-L
K2-U
K2-L
Moulds
Shade Numbers
10
11
12
13
15
17
20
21
22
23
24
26
27
31
32
39
40
41
Lower Anterior
U22
n/a
U25
U32
n/a
U33
n/a
U34
U37
U38
U67
U70
n/a
U74
n/a
U86
U88
n/a
U90
n/a
U92
n/a
Lower & Upper Posterior 28 Degree
28-U
n/a
28-L
n/a
30-U
30-L
30K-U
30K-L
n/a
32-U
32-L
32K-U
n/a
32K-L
n/a
34-U
34-L
36-U
n/a
36-L
n/a
Fax: 1-210-684-4473
Confirmation of Order will follow.
Email: sales@tq-acrylicteeth.com
Phone Toll Free: 1-866-794-8580
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