Sales Order Form

Complete form to order Solmetex, DryShield and/or Sterisil products:

Submitted by/Sales Rep(Required)

Order Source(Required)

Territory(Required)

Territory Map

Solmetex Products

#1 Solmetex Product

Quantity (SP1)(Required)

If Other Product, Specify SKU # (SP1)(Required)

#2 Solmetex Product

Quantity (SP2)(Required)

If Other Product, Specify SKU # (SP2)(Required)

#3 Solmetex Product

Quantity (SP3)(Required)

If Other Product, Specify SKU # (SP3)(Required)

#4 Solmetex Product

Quantity (SP4)(Required)

If Other Product, Specify SKU # (SP4)(Required)

#5 Solmetex Product

Quantity (SP5)(Required)

If Other Product, Specify SKU # (SP5)(Required)

#6 Solmetex Product

Quantity (SP6)(Required)

If Other Product, Specify SKU # (SP6)(Required)

#7 Solmetex Product

Quantity (SP7)(Required)

If Other Product, Specify SKU # (SP7)(Required)

#8 Solmetex Product

Quantity (SP8)(Required)

If Other Product, Specify SKU # (SP8)(Required)

Solmetex Promotions

#1 Available Q1 Solmetex Promotions

Solmetex Rebate Form Submission Required for Offers #1, #2, & #3

#2 Available Q1 Solmetex Promotions

#3 Available Q1 Solmetex Promotions

#4 Available Q1 Solmetex Promotions

Solmetex Products Order Notes

Dryshield Products

#1 DryShield Product

Quantity (DP1)(Required)

If Other Product, Specify SKU # (DP1)(Required)

#2 DryShield Product

Quantity (DP2)(Required)

If Other Product, Specify SKU # (DP2)(Required)

#3 DryShield Product

Quantity (DP3)(Required)

If Other Product, Specify SKU # (DP3)(Required)

#4 DryShield Product

Quantity (DP4)(Required)

If Other Product, Specify SKU # (DP4)(Required)

#5 DryShield Product

Quantity (DP5)

If Other Product, Specify SKU # (DP5)(Required)

#6 DryShield Product

Quantity (DP6)

If Other Product, Specify SKU # (DP6)(Required)

#7 DryShield Product

Quantity (DP7)

If Other Product, Specify SKU # (DP7)(Required)

#8 DryShield Product

Quantity (DP8)

If Other Product, Specify SKU # (DP8)(Required)

Dryshield Promotions

#1 Available Q1 DryShield Promotions

#2 Available Q1 DryShield Promotions

#3 Available Q1 DryShield Promotions

#4 Available Q1 DryShield Promotions

DryShield Free Goods

DryShield Order Notes

Sterisil Products

#1 Sterisil Product

Quantity (ST1)(Required)

If Other Product, Specify SKU # (ST1)(Required)

#2 Sterisil Product

Quantity (ST2)(Required)

If Other Product, Specify SKU # (ST2)(Required)

#3 Sterisil Product

Quantity (ST3)(Required)

If Other Product, Specify SKU # (ST3)(Required)

#4 Sterisil Product

Quantity (ST4)(Required)

If Other Product, Specify SKU # (ST4)(Required)

#5 Sterisil Product

Quantity (ST5)(Required)

If Other Product, Specify SKU # (ST5)(Required)

#6 Sterisil Product

Quantity (ST6)(Required)

If Other Product, Specify SKU # (ST6)(Required)

#7 Sterisil Product

Quantity (ST7)(Required)

If Other Product, Specify SKU # (ST7)(Required)

#8 Sterisil Product

Quantity (ST8)(Required)

If Other Product, Specify SKU # (ST8)(Required)

Sterisil Promotions

#1 Available Q1 Sterisil Promotions

#2 Available Q1 Sterisil Promotions

#3 Available Q1 Sterisil Promotions

#4 Available Q1 Sterisil Promotions

What mounting type do you need? (G4)

What mounting type do you need? (G5)

How will this be fed? (G5)

Sterisil Order Notes

Doctor / Practice Information

Doctor First Name(Required)

Doctor Last Name(Required)

Practice Name(Required)

City(Required)

State(Required)

Zip(Required)

Practice Phone(Required)

Practice Email

Dental Dealer of Choice(Required)

If other, please specify dealer

Solmetex Customer #

Office Staff Authorizing Order(Required)

Would you like to send a copy of this order to anyone else? Enter an email address below

The effectiveness of microbial treatment products

Risk of waterborne infections

Protect the health and safety of patients and dental staff.

Our evacuation product solutions include NXT^® DryVac, DryShield^®, and PowerScrub^™

Accommodates up to 10 operatories

Our Waste Management product solutions includes the PWS

Take advantage of limited time offers on key Water Solutions today!

Sterisil^® Water System

DryShield^® Autoclavable All-In-One Isolation System

Dental Water Safety Education

For over 25 years, Solmetex has been an innovator in waste solutions

All deals available now!

Follow Regulations

Access Documents

Track Results

Set Up Deliveries

Enroll Products

Report Issues

Expert Support

Print Recycle Shipping Label

Print Recycle Certificate

End-to-End Dental Water Management Products

Sales Order Form

Complete form to order Solmetex, DryShield and/or Sterisil products:

Solmetex Products

Solmetex Promotions

Dryshield Products

Dryshield Promotions

Sterisil Products

Sterisil Promotions

Doctor / Practice Information

Let’s talk water quality

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Contact

Partnerships

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Solmetex®, llc

NEED HELP?

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The effectiveness of microbial treatment products

Risk of waterborne infections

Protect the health and safety of patients and dental staff.

Our evacuation product solutions include NXT® DryVac, DryShield®, and PowerScrub™

Accommodates up to 10 operatories

Our Waste Management product solutions includes the PWS

Take advantage of limited time offers on key Water Solutions today!

Sterisil® Water System

DryShield® Autoclavable All-In-One Isolation System

Dental Water Safety Education

For over 25 years, Solmetex has been an innovator in waste solutions

All deals available now!

Follow Regulations

Access Documents

Track Results

Set Up Deliveries

Enroll Products

Report Issues

Expert Support

Print Recycle Shipping Label

Print Recycle Certificate

End-to-End Dental Water Management Products

Sales Order Form

Sales Order Form

Complete form to order Solmetex, DryShield and/or Sterisil products:

Solmetex Products

Solmetex Promotions

Dryshield Products

Dryshield Promotions

Sterisil Products

Sterisil Promotions

Doctor / Practice Information

Solmetex®, llc

NEED HELP?

Our evacuation product solutions include NXT^® DryVac, DryShield^®, and PowerScrub^™

Sterisil^® Water System

DryShield^® Autoclavable All-In-One Isolation System