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DentalLabServices. com For King Hue Cross Linked Acrylic Teeth UPPER ANTERIORS 1X6 LOWER ANTERIORS 1X6 714 282-1675 Total B3 3N 2P 2N A26 A25 A24 3D 2D 3M 3P 1H 4H Visit www. Account/Name Date Purchase Order No Shipping Address Phone Fax City State Zip FAX COMPLETED TOOTH FORM TO DLS Tooth Order Form Mould SHADE/COLOR DLS Corporation 246 West Taft Avenue Orange CA-USA 92865 Toll Free 1-800-514-7063 www. dentallabservices. com/toothcounter. htm for chart. UPPER POSTERIORS 1X8 LOWER POSTERIORS 1X8 31Z 32F 33F 29M 29L 31M 31L 33M 30M 30L 32M 32L 34M 34L Darker lines indicate degree change 0o 10o 20o or 33o. CREDIT INFORMATION Type Visa MasterCard Discover AmerEx Security Code Print Cardholders Name Signature Exp / Billing Address Terms Will Call Ship Ground Day Air Tooth Card Total Indicate method of payment My Established DLS Account Credit Card C. O. D. I Wish to Open an Account attach credit application Thank you for your order Sub-Total Freight Sales Tax TOTAL. dentallabservices. com/toothcounter. htm for chart. UPPER POSTERIORS 1X8 LOWER POSTERIORS 1X8 31Z 32F 33F 29M 29L 31M 31L 33M 30M 30L 32M 32L 34M 34L Darker lines indicate degree change 0o 10o 20o or 33o. CREDIT INFORMATION Type Visa MasterCard Discover AmerEx Security Code Print Cardholders Name Signature Exp / Billing Address Terms Will Call Ship Ground Day Air Tooth Card Total Indicate method of payment My Established DLS Account Credit Card C. CREDIT INFORMATION Type Visa MasterCard Discover AmerEx Security Code Print Cardholders Name Signature Exp / Billing Address Terms Will Call Ship Ground Day Air Tooth Card Total Indicate method of payment My Established DLS Account Credit Card C. O. D. I Wish to Open an Account attach credit application Thank you for your order Sub-Total Freight Sales Tax TOTAL. dentallabservices. com/toothcounter. htm for chart. UPPER POSTERIORS 1X8 LOWER POSTERIORS 1X8 31Z 32F 33F 29M 29L 31M 31L 33M 30M 30L 32M 32L 34M 34L Darker lines indicate degree change 0o 10o 20o or 33o. CREDIT INFORMATION Type Visa MasterCard Discover AmerEx Security Code Print Cardholders Name Signature Exp / Billing Address Terms Will Call Ship Ground Day Air Tooth Card Total Indicate method of payment My Established DLS Account Credit Card C. O. D. I Wish to Open an Account attach credit application Thank you for your order Sub-Total Freight Sales Tax TOTAL.

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