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M O Yale Dental, Inc 1 Seitz Lane Cos Cob, CT 06807 www

M O Yale Dental, Inc 1 Seitz Lane Cos Cob, CT 06807 www 2025

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The document is a service order form from M. O. Yale Dental, Inc., detailing various dental instrument retipping and sharpening services, including pricing for each type of service. It includes sections for customer information, confirmation of sterilization, itemization of instruments, shipping costs, and payment options.

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Click ‘Get Form’ to open the document in the editor.
Begin by entering your personal information in the designated fields: Name, Phone Number, Address, City, State, ZIP Code, and Email Address.
Confirm that all instruments are sterilized by initialing in the provided space.
Select any retipping or sharpening services you require by checking the appropriate boxes next to each service listed.
For ultrasonic insert retipping service, indicate your frequency preference by selecting either 25k or 30k.
Itemize your instruments in the provided section. Include comments and prices for each item as necessary.
Calculate shipping costs based on the total number of instruments sent and enter this amount in the Total field.
Choose your payment method by checking one of the options available and fill in any required details such as Billing Zip Code and CVV Code.

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