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=================== Cut by this line, fill out and enclose with your order =========

REPAIR INFORMATION CARD

Please forward my repaired handpiece to: (no P.O. Boxes, please)

Name: _______________________________________________

Address: ____________________________________________

City, State, ZIP code: ______________________________

Phone number: (________) ____________________________

Email: ______________________________________________

The following sterilized handpieces are enclosed:

------------- Product ---------- Serial No. ------------- Describe the problem
1.
2.
3.
4.
5.

Comments: _____________________________________________

Please note: Your repair will be returned to you via FedEx. An estimate will be given upon request. Please do not leave bur in your handpiece/attachment, as it will NOT be returned to you upon completion of repair. No P.O. Boxes, please. Please affix the label (above) to the box and enclose this Card. Volume repairs will be entitled to our same day FedEx pick-up. Call us at 800 874-1212 and we'll dispatch. Your handpiece will be at your facility tomorrow.