Request FREE Samples Alpen's Z-Rex Burs "*" indicates required fields Residing Country* United States Canada I Would Like to* Request a Sample Place an Order You will be able to select your preferred U.S. or Canadian dealer, who will then process and fulfill your order.This field is hidden when viewing the formUntitledContact InformationPractice Name*National Physician ID No.*(required for US doctors)Name* Prefix TitleDr.MissMr.Mrs.Ms.Prof. First Last Phone*Email* Please Select Your Sample Choice* 60031901 G801Z-314-014-01.4-M, Alpen Diamonds 60031813 G379Z-314-023-05.0-M, Alpen Diamonds 60032621 G881Z-314-016-08.0-C, Alpen Diamonds This field is hidden when viewing the form(hidden) Alpen Z-Rex, 60031901This field is hidden when viewing the form(hidden) Alpen Z-Rex, 60031813This field is hidden when viewing the form(hidden) Alpen Z-Rex, 60032621Order Selection and Preferred DealerWill your order include multiple part numbers for Alpen Z-Rex Diamonds?* Yes No Product Selection*Please Select60031901 G801Z-314-014-01.4-M, Alpen Diamonds60031903 G801Z-314-018-01.8-M, Alpen Diamonds60032241 G850Z-314-016-10.0-M, Alpen Diamonds60032621 G881Z-314-016-08.0-C, Alpen Diamonds60031813 G379Z-314-023-05.0-M, Alpen Diamonds60031899 G801Z-314-012-01.2-M, Alpen Diamonds60032467 G862Z-314-014-08.0-M, Alpen Diamonds60032481 G863Z-314-014-10.0-M, Alpen Diamonds60032243 G850Z-314-018-10.0-M, Alpen Diamonds60032379 G856Z-314-018-08.0-M, Alpen Diamonds60032619 G881Z-314-014-08.0-M, Alpen DiamondsQuantity*Product Selection*Please Select60031901 G801Z-314-014-01.4-M, Alpen Diamonds60031903 G801Z-314-018-01.8-M, Alpen Diamonds60032241 G850Z-314-016-10.0-M, Alpen Diamonds60032621 G881Z-314-016-08.0-C, Alpen Diamonds60031813 G379Z-314-023-05.0-M, Alpen Diamonds60031899 G801Z-314-012-01.2-M, Alpen Diamonds60032467 G862Z-314-014-08.0-M, Alpen Diamonds60032481 G863Z-314-014-10.0-M, Alpen Diamonds60032243 G850Z-314-018-10.0-M, Alpen Diamonds60032379 G856Z-314-018-08.0-M, Alpen Diamonds60032619 G881Z-314-014-08.0-M, Alpen DiamondsQuantity*Product SelectionPlease Select60031901 G801Z-314-014-01.4-M, Alpen Diamonds60031903 G801Z-314-018-01.8-M, Alpen Diamonds60032241 G850Z-314-016-10.0-M, Alpen Diamonds60032621 G881Z-314-016-08.0-C, Alpen Diamonds60031813 G379Z-314-023-05.0-M, Alpen Diamonds60031899 G801Z-314-012-01.2-M, Alpen Diamonds60032467 G862Z-314-014-08.0-M, Alpen Diamonds60032481 G863Z-314-014-10.0-M, Alpen Diamonds60032243 G850Z-314-018-10.0-M, Alpen Diamonds60032379 G856Z-314-018-08.0-M, Alpen Diamonds60032619 G881Z-314-014-08.0-M, Alpen DiamondsQuantityPreferred Dealer*Please Select3Z DENTALACME DENTALAM-TOUCH DENTALATLANTA DENTALBENCO DENTALBURKHART DENTALCAROLINA DENTALCENTRAL DENTAL TORONTOCENTRAL DENTAL WINNIPEGCERUM DENTALDARBY DENTALDAVIS DENTALDC-DENTAL (USA-VERSION)DDS DENTALDENTAL BRANDSDENTAL CITYDHPDIATECHFRONTIER DENTAL SUPPLYGOETZE DENTALHEALTHCARE SUPPLY CORPORATIONHENRY SCHEIN CANADAHENRY SCHEIN USAIQ DENTALJOHNSON AND LUND DENTALK-DENTALKINGS TWO DENTALLAB DEPOTMEDISELECT DENTALMIDWAY DENTALMIDWEST DENTALMS DENTALNASHVILLE DENTALNEWARK DENTALNORTHERN SURGICALNOWAKOC DENTALPATTERSON DENTALPATTERSON DENTAL CANADAPEARSON DENTALPREFERRED DENTAL SERVICESPURE LIFE DENTALSAFCO CANADASAFCO DENTALSCOTT'S DENTALSINCLAIR DENTALSKY DENTALSUPPLYDOCTOP QUALITY DENTALTRISTATE DENTALVALUEMEDYOUNGS DENTALOtherDelivery AddressPlease Enter Your Delivery AddressPlease Enter Your Delivery Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please Enter Your Delivery Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Billing AddressPlease Enter Your Billing AddressPlease Enter Your Billing Address* Same as previous Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Please Enter Your Billing Address* Same as previous Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Would you be interested in a Lunch & Learn session for this product?* Yes No I'm Unsure Not a problem. Would you like more information about our Lunch & Learns?* Yes No We're pleased to hear of your interest in our Lunch & Learn sessions. You will receive a follow-up email shortly from your local COLTENE representative.We're pleased to hear of your interest in learning more about our Lunch & Learn sessions. You will receive a follow-up email shortly with further details.Thank you for expressing your preferences. Should you have a change of heart or any questions regarding our Lunch & Learn events, please do not hesitate to get in touch. We hope you enjoy the sample(s) we're providing and would appreciate your feedback on your experience.How Did You Learn About COLTENE?Please SelectDistributorFacebookInstagramLinkedInTwitterTikTokVivaLearningOtherPlease Share How You Learned About UsWould You Mind Sharing the Name of Your Distributor?Please Select3Z DENTALACME DENTALAM-TOUCH DENTALATLANTA DENTALBENCO DENTALBURKHART DENTALCAROLINA DENTALCENTRAL DENTAL TORONTOCENTRAL DENTAL WINNIPEGCERUM DENTALDARBY DENTALDAVIS DENTALDC-DENTAL (USA-VERSION)DDS DENTALDENTAL BRANDSDENTAL CITYDHPDIATECHFRONTIER DENTAL SUPPLYGOETZE DENTALHEALTHCARE SUPPLY CORPORATIONHENRY SCHEIN CANADAHENRY SCHEIN USAIQ DENTALJOHNSON AND LUND DENTALK-DENTALKINGS TWO DENTALLAB DEPOTMEDISELECT DENTALMIDWAY DENTALMIDWEST DENTALMS DENTALNASHVILLE DENTALNEWARK DENTALNORTHERN SURGICALNOWAKOC DENTALPATTERSON DENTALPATTERSON DENTAL CANADAPEARSON DENTALPREFERRED DENTAL SERVICESPURE LIFE DENTALSAFCO CANADASAFCO DENTALSCOTT'S DENTALSINCLAIR DENTALSKY DENTALSUPPLYDOCTOP QUALITY DENTALTRISTATE DENTALVALUEMEDYOUNGS DENTALThis field is hidden when viewing the formTERRITORY / REG. MGRS (USA)This field is hidden when viewing the formGET ZIP CODE (USA)(searches google sheet)This field is hidden when viewing the formTerritory Mgr. (USA)(Dynamic Population)This field is hidden when viewing the formRegional Mgr. (USA)(Dynamic Population)This field is hidden when viewing the formTerritory Mgr. Email (USA)(Dynamic Population)This field is hidden when viewing the formRegional Mgr. Email (USA)(Dynamic Population)This field is hidden when viewing the formTERRITORY / REG. MGRS (CA)This field is hidden when viewing the formGET ZIP CODE (CA)(searches google sheet)This field is hidden when viewing the formTerritory Mgr. (CA)(Default to Taylor G.)This field is hidden when viewing the formRegional Mgr. (CA)(Dynamic Population)This field is hidden when viewing the formTerritory Mgr. Email (CA)(Default to Taylor G.)This field is hidden when viewing the formRegional Mgr. 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