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SmartLite Pro Trade Up Program
Promotion Valid Until March 31, 2024
Customer Information
Customer Name
*
First Name
Last Name
Customer Email
*
example@example.com
Practice Name
*
Practice Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Customer Phone Number
*
Dentsply Sirona Chairside Specialist
Please Select
Jean Crawshaw -BC
Joanne Hovey -BC
Michelle Boucher - BC
Sheena Fiander-AB
Nicolette Tessier - AB
Jennifer Reyes -AB
Kristy Charlton -SK
Kylee Zylberman -MB
Lisia Malcolm -ON
Manny Gill -ON
Marc Pelletier -ON
Michael Hannan -ON
Paul Khazzaka -ON
Tabitha Thompson - ON
Tom Giftakopoulos -ON
Diane Bellemare -QC
Martin Durand -QC
Pier-Luc Boucher - QC
Rima Ambaraghassi -QC
Natalie Hayes -NS/NB/PEI/NFLD
Authorized Distributor
*
Please Select
Patterson Dental
Henry Schein
Sinclair Dental
K-Dental
Other
Dealer Representative Name:
First Name
Last Name
Invoice date
*
-
Month
-
Day
Year
Date
Invoice/ Order Number
*
Certification
*
I certify that the trade-in curing light unit has been traded in, removed from the office, and disposed of properly.
Attach Invoice
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Attach Picture of Old curing light
*
Browse Files
Drag and drop files here
Choose a file
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of
Please Select Free Good (choose 1)
*
7x TPH Spectra ST HV A2 - 642232(compules box 20)
7x TPH Spectra ST LV A2- 642221 (compules box 20)
8x Surefil SDR+ A2 compula 61C107
14x Surefil SDR+ syringes Universal 61C130
Please have my Dentsply Sirona Rep contact me
Please see comments below
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