REQUEST FREE SAMPLES

OR ORDER FROM YOUR PREFERRED DEALER

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Residing Country*

United States

Canada

I Would Like to*

Request a Sample

Place an Order through my Dealer

Request an in Office Demo

Request a Lunch & Learn

Request Contact by Local Rep

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Request Info (hidden field for mapping)

i would like to (request info)

You will be able to select your preferred U.S. or Canadian dealer, who will then process and fulfill your order.

Contact Information

Practice Name*

National Physician ID No.*

(required for US doctors)

Name*

Prefix First Last

Phone*

Email*

Sample Selection

Please Select Your Sample Choice*

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(hidden) HyFlex EDM Max Curve Set 21mm

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(hidden) HyFlex EDM Max Curve Set 25mm

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(hidden) HyFlex EDM Shaping Set Simple 21mm

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(hidden) HyFlex EDM Shaping Set Simple 25mm

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(hidden) One RECI Extra Small 20/.04

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(hidden) One RECI Small 25/.04

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(hidden) One RECI Primary 25/.06

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(hidden) One RECI Medium 35/.04

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(hidden) One RECI Large 45/.04

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(hidden) HyFlex EDM OGSF Sequence 21mm

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(hidden) HyFlex EDM OGSF Sequence 25mm

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(hidden) Request Info

Order Selection and Preferred Dealer

Will your order include multiple part numbers?*

Yes

Product Selection*

Quantity*

Product Selection*

Quantity*

Product Selection

Quantity

Preferred Dealer*

Delivery Address

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Please Enter Your Delivery Address*

Street Address Address Line 2 City State ZIP Code

Please Enter Your Delivery Address*

Street Address Address Line 2 City Province Postal Code

Billing Address

Please Enter Your Billing Address

Please Enter Your Billing Address*

Same as previous

Street Address Address Line 2 City Province Postal Code

Please Enter Your Billing Address*

Same as previous

Street Address Address Line 2 City State ZIP Code

Would you be interested in a Lunch & Learn session for this product?*

Yes

I'm Unsure

Not a problem. Would you like more information about our Lunch & Learns?*

Yes

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 Share How You Learned About Us

Would You Mind Sharing the Name of Your Distributor?

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TERRITORY / REG. MGRS (USA)

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GET ZIP CODE (USA)

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Territory Mgr. (USA)

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Regional Mgr. (USA)

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Territory Mgr. Email (USA)

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TERRITORY / REG. MGRS (CA)

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GET ZIP CODE (CA)

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Territory Mgr. (CA)

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Regional Mgr. (CA)

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Territory Mgr. Email (CA)

(Dynamic Population)

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Regional Mgr. Email (CA)

(Dynamic Population)

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TERMS

Terms*

I agree to the terms of service

YOUR ORDER IS BILLED BY YOUR DEALER. Prices, taxes, and shipping will be determined and billed by your preferred dealer.

OGSF Sequence

Learn More

HyFlex EDM File System

Learn More

MicroMega One RECI File System

Learn More

330.916.8800

235 Ascot Parkway, Cuyahoga Falls, OH 44223