2511 27th Ave
San Francisco, CA 94116
Please fill out this form and send in payment to the address above along with any broken handpieces you may already have. This information is important so that I can start stocking the necessary parts for your office.
Office Name and address: (Please print clearly)
Handpiece Make& Model Serial Number
*Please note the $50 a month fee is based on the average office having a dozen handpieces in operation. If you office has over 12 handpieces. There is a $5 fee for each additional handpiece per month. Please use the back if you have additional handpieces.