pH Dental Order Form

Please select which representative assisted you or made you aware of our company!

PAX 2000 EXTRAORAL SUCTION SYSTEM

PAX 2000X EXTRAORAL SUCTION SYSTEM

ATOMIZERS & HOCl FLUID

CLEAN AIR

MASKS/RESPIRATORS

GOWNS

GLOVES

FACE SHIELDS

OTHER SAFETY EQUIPMENT

SHIPPING INFORMATION

BILLING INFORMATION

DELIVERY OPTIONS

* Shipping cost varies based on quantity and shipping address.
If the payment date falls on a weekend or holiday, I understand that the payments may be executed on the next business day. I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. ALL SALES ARE FINAL AND CANNOT BE RETURNED