White Teeth Center
"Welcome To Our White Teeth Center"
If you are unable to visit our office, you can order your refill
tubes of tooth whitening gel for home use by ordering online right here. You
will need your custom constructed bleaching trays for your teeth to use this
refill system in the prescribed manner.
Our refill deal for $ 28.00 includes:
-
Three tubes of Opalescence tooth whitening gel
Products Order Form
Print these two forms and mail with your check
or credit card information with your shipping information.
For each product you wish to order, check the checkbox to the left of
the line and specify the desired quantity in the Qty box on the right.
|
a |
Item |
Unit Price |
Qty |
| Opalescence Whitening Gel | |||
|
1 tube |
$10.00 | ||
|
3 tubes |
$28.00 | ||
| 6 tubes | $52.00 | ||
|
12 tubes |
$110.00 | ||
| Shipping & Handling Cost $5 under $50 sales |
|||
| $10 over $50 sales | |||
| Total Due | $ |
|
CREDIT CARD INFO &
SHIPPING FORM: Name as it appears on
|