Tradeshow Sales Order Form

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

Submitted by/Sales Rep(Required)

Order Source(Required)

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)(Required)

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

#6 DryShield Product

Quantity (DP6)(Required)

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

#7 DryShield Product

Quantity (DP7)(Required)

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

#8 DryShield Product

Quantity (DP8)(Required)

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