ORDER FORM

DESCRIPTION QTY UNIT PRICE DESCRIPTION QTY UNIT PRICE

PRIC PRIC
E E
Tooth 18 $6 Mouth Mirror $15
Tooth 17 $6 Tweezer $15
Tooth 16 $6 Perio Probe $26
Tooth 15 $6 Endo Probe $15
Tooth 14 $6 Explorer $15
Tooth 13 $6 Spoon Excavator $15
Tooth 12 $6 Flat Plastic $15
Tooth 11 $6 Small Condenser $15
Tooth 21 $6 Large Condenser $15
Tooth 22 $6 Ball burnisher $15
Tooth 23 $6 Amalgam Carrier $20
Tooth 24 $6 Hollenback Carver $15
Tooth 25 $6 GMT 28 & 29 $15
Tooth 26 $6 Caliper $15
Tooth 27 $6 Tofflemire Retainer $25
Tooth 28 $6 Bur holder $15
Tooth 38 $6 Matrix Bands set (12 $3
bands)
Tooth 37 $6 Abrasive Strips 4mm $4
Tooth 36 $6 Abrasive Strips 6mm $4
Tooth 35 $6 Superbuf $2.5
Tooth 34 $6 Polishing Brush Cup $5
Tooth 33 $6 Polishing Brush Point $5
Tooth 32 $6 Wooden wedges Wide $0.5
Tooth 31 $6 Wooden wedges $0.4
Narrow
Tooth 41 $6 Finishing Point $4
Tooth 42 $6 Finishing Cup $4
Tooth 43 $6 Amalgam capsule Spill $1.5
1
Tooth 44 $6 Amalgam capsule Spill $2.5
2
Tooth 45 $6 Amalgam capsule Spill $3.5
3
Tooth 46 $6 Kerr contour Spill 2 $4
Tooth 47 $6 Ivoclar Packable $35
Composite
Tooth 48 $6 Ivoclar Flowable $25
Composite
ENDO Tooth 16 $35
ENDO Tooth 26 $35
CARIES Tooth 12 $18 Temp gun $60

NAME DATE
ADDRESS PHONE NO.
CARIES Tooth 46 $18 Temp gun tip $0.5
Prepared tooth endo $40
Prepared tooth $30 Rubber dam Sheet $0.9
-Regular
Screws $1 Rubber dam sheet - $4.5
Non-latex

DESCRIPTION QTY UNI PRI DESCRIPTION QT UNIT PRIC

T CE Y PRIC E
PRI E
CE
Fender Wedge Yellow $2 CAVITY
$2 0.8mm round bur $5
Orange
$2 0.8mm cyl bur $5
Green
$2 Yellow pear shape $5
Purple

Celluloid strip box $20 ENDO

Polishing strips 2.5 mm $0. Long shank $14
3
Polishing strips 4 mm $0. Endo bur $18
3
Polishing discs white $0.
5
$0. Yellow torpedo bur $6
Yellow 5
Lt. $0. Yellow tapered round $5
green 5
Dark $0. Yellow tapered flat $5
green 5
Soflex Discs Coarse $1 Yellow band round bur $5
Medium $1 0.5mm carbide bur $6
Fine $1 0.6mm carbide bur $6
Superfine $1 0.9mm carbide bur $6

PFM Bur Kit $42 Converter $15

FGC bur kit $25 Mandrel (Soflex/super $7
buf)
Cavity bur kit $20
Endo bur kit $32 X Ray Film Size 1 $1.5
X Ray Film Size 2 $1
FGC
1mm round bur $5 Slow hand piece $25
Chamfer bur $5 Motor $25
Interprox bur $5 Fast hand piece w/o led $40
Red chamfer $5 Fast hand piece with $75
led
Red interprox $5
NAME DATE
ADDRESS PHONE NO.
Tapered Red diatech $11 Blue wax 1 strip $1
round end

PFM
1mm shoulder $5
Interprox bur $5
Diatech blue band $11
Interprox bur
Yellow shoulder $5
Yellow football $5
1.2mmcylindrical $11
diatech
Tapered red diatech $11

NAME DATE
ADDRESS PHONE NO.