(Use the tab key to enter your information) Email Order Form PROFESSIONAL DISCOUNT OFFER Sonicare FlexCare

Plus w/ UV Sanitizer Sonicare Professional Sales 1 handle, 1 standard BH, 1 compact BH, UV sanitizer, travel case Lee.Somerville@Philips.com 0……… $49.95 EA $0.00 Encrypted Secure Fax: (866) 696-8006 (Limit 1) Contact Information: (US Orders Only) FRIENDS AND FAMILY GIFT OFFER Sonicare FlexCare Plus w/ UV Sanitizer (Same packaging as above) Name (First) (Last) (Credentials) 0……… $69.95 EA $0.00 Date: Professional Educator: Lee Somerville, RDH, MS School/Organization: Please Check One: Dentist RDH CDA/DA DH Student Admin Resident DA Student 0………. $29.95 EA $0.00
(Limit 2) (Limit 4)

Sonicare for Kids
1 handle, 1 Age 4+ BH, 1 Age 7+ BH, 3 interchangeable face plates

**Please Indicate Brush Head Size (Standard or Compact) Below**

Sonicare FlexCare+ Brush Heads (ProResults)

Standard #0

Compact # 0

Dental Student Employer or School Address City/State/Zip Office Phone ( )

1-5 qty Triple pack(s)……..........................$19.95 EA 6-17 qty Triple packs………………………….$16.95 EA 18+ qty Triple packs……………………….…$14.95 EA Good Value Two (2) Triple packs/$39.90……………… 0 $19.95 EA $0.00 Better Value Six (6) Triple packs/$101.70……………… 0 $16.95 EA $0.00 Best Value Eighteen+ (18) Triple packs/$269.10 …… 0 $14.95 EA $0.00 e-series Brush Heads
(Advance, Elite, Essence, Xtreme)

Practice/Post Graduate Specialty: GP Perio Ortho Pediatric Prosth OMFS

Shipping Address (no PO boxes, US addresses only) Street Apt/Ste City, State, Zip Required for delivery Phone ( Email Address
Yes, keep me up to date with Philips news, promotions and surveys. I confirm that I am 14 years of age or older.

Standard #0 Compact #0

1-5 qty )

Double pack(s)…………………..0 $19.95 EA $0.00

6-17 qty Double packs….………………...0 $16.95 EA $0.00 Sonicare For Kids Brush Heads Age 4+ #0 Age 7+ #0

Payment Information: Visa Card # Expiration Date MC AmEx

1-5 qty Double pack(s)………………... 0 $14.95 EA $0.00 6-17 qty Double packs……………….… 0 $12.95 EA $0.00 18+ qty Double packs…………………. 0 $11.95 EA $0.00 Accessories & Literature
Patient Script Pad Education Brochures # 0 Mr. Palmer (Periodontal Disease) # 0 Emily & Sarah (Orthodontic) # 0 Tony (Healthy Patient) # 0 Steve (Sensitivity) available Oct ‘10

Free
#0 # 0 Rachel (Whitening) # 0 Sophia (Pediatric) # 0 Mary (Implants) available Dec ‘10

Name on Card
Upon completion, print and fax to encrypted secure fax # (866) 696-8006

The section below will be calculated by Philips Sonicare

Subtotal $

(10% of subtotal, $15 max) Shipping & Handling (will be automatically added based on zip code) Tax Philips values and respects your privacy, please visit us at: www.philips.com/privacypolicy to read our privacy policy © 2010 Philips Consumer Lifestyle Rev 9-10 TOTAL

$_________ $_________ $_________

Sign up to vote on this title
UsefulNot useful