clicking here - Friends of Hu-Friedy

INSTRUCTIONS
1. YOUR OFFICE PROFILE
1. Complete your office profile information.
2. PRODUCT CATEGORIES
1. Determine your estimated annual volume for each product you would like to receive and write it
in the 12 Month Total Units (Column A).
2. Determine how you would like to schedule your shipments over the year.
Enter the desired quantities in the monthly columns you wish to take deliveries.
Be sure the total of the individual monthly shipments equals the 12 Month Total Units (Column A).
3. Multiply the 12 Month Total Units (Column A) by the HUSAVE Price (Column B) and enter the
amount in the Total 12 Month Purchases (Column C). (AxB=C)
4. Total your purchases at the bottom of each category. Be sure your total meets the annual minimum
purchase for that category (i.e., Cleaning and Care annual minimum is $300.00).
5. Indicate your dealer of choice for invoicing.
6. Sign and date the agreement.
7. Make a copy for your office.
8. Mail or fax the order to Hu-Friedy at:
HUSAVE Volume Savings Program
3232 N. Rockwell St.
Chicago, IL 60618 USA
Fax: 1-800-729-1299
Questions please contact customer service at 1-866-HUSAVE3
3. YOUR REBATE POTENTIAL
1. Calculate your rebate potential (back panel).

3. YOUR REBATE POTENTIAL
At the end of each calendar year you may qualify for rebates of 2-6%. You earn a 2% rebate for each
category in which you have a qualifying HUSAVE order. For example, if you have met minimum qualifying
purchases in all three categories you will receive a 6% rebate on all HUSAVE products purchased. The
categories are clearly indicated on the order form as well as being color-coded for easy recognition:
Cleaning and Care (gold), Sterilization (green) and Disposable Instruments (blue).
Your rebate is paid within 60 days of the end of the calendar year.
1. Enter your total planned purchases per product category from the order form in Column 1 below.
(i.e. total Cleaning and Care, Sterilization and Disposable Instruments)
2. For each category where you have met minimum qualifying HUSAVE purchases, put 2% in Column 2
to the right of your total purchases.
3. Add up the Totals –
a. In Column 1 below add up your total purchases for all categories for the year where you have met
minimum purchase requirements.
b. In Column 2 below add up your rebate percentage from the categories where you have
qualifying HUSAVE purchases.
4. Multiply the Sum of Total Purchases by the Sum of Total Rebate Percentages to determine your Annual
Rebate. Rebate is dependent on actual purchases and meeting minimum annual requirements.
Category
CLEANING & CARE $300
STERILIZATION $900
Category
STERILIZATION $900
EXAMPLE
Minimum
Requirement
DISPOSABLE INSTRUMENTS $1,400
Minimum
Requirement
CLEANING & CARE $300
DISPOSABLE INSTRUMENTS $1,400
Your Total
Purchases
1
1
1
Sum Total Purchases Sum Total Rebate %
Your Total
Purchases
Qualifying HUSAVE
Purchase? Enter 2%
Qualifying HUSAVE
Purchase? Enter 2%
$ 500 2 %
$ 0 0 %
$ 1,400 2 %
ANNUAL
REBATE
$ 1,900 x = $76.00
2
2
2
x =
4 %

HUSAVE SM
Order Form
3 step ORDER FORM
Use this simple three step process to start saving today.
1. YOUR OFFICE PROFILE
2. PRODUCT CATEGORIES
3. YOUR REBATE POTENTIAL
Complete Your Office Profile Information
Indicate the Products You Want In Each Category
and Your Dealer of Choice
Calculate Your Rebate Potential (back panel)

1. YOUR OFFICE PROFILE
To ensure proper processing, please fill out the information below completely.
Ship to: Bill to: (if different address)
Name (Authorized Signor) Name
Practice Name Street
Street City, State, Zip code
City, State, Zip code DDS License #
Office Phone ( ) Practice Specialty
Office Fax ( )
Office Email
2. PRODUCT CATEGORIES
pricing effective 1-1-2006 through 12-31-2006
Would you like to become part of our new product evaluation process?
Would you like Hu-Friedy to confirm shipment each month? Y N
If yes, how? E-mail Written Reminder
ABC
Price (Jan–Dec) Purchases
Item Description Hu-Friedy Sugg. HUSAVE J F M A M J J A S O N D 12 Month HUSAVE Total
Part Code Retail Price Total Units Price 12 Month
CLEANING & CARE
ENZYMAX
SAVE 25%
*total number of gallons made
® DUAL-ENZYME DETERGENT
Enzymax, Box of 40, 1/3oz Pkts, 40 gal.* IMS-1222 $ 70.50 $ 52.90 $ 52.90
Enzymax, Case of 10 Boxes, 400 gal.* IMS-1222C $ 668.00 $ 501.00 $ 501.00
Enzymax, Quart Bottle, 32 gal.* IMS-1224 $ 34.10 $ 25.60 $ 25.60
Enzymax, Case of 12 qt. Bottles, 384 gal.* IMS-1224C $ 388.00 $ 291.00 $ 291.00
Enzymax, Gallon Bottle, 128 gal.* IMS-1226 $ 68.50 $ 51.40 $ 51.40
Enzymax Powder, 800 gm, 50 gal.* IMS-1230 $ 45.90 $ 34.40 $ 34.40
Enzymax, 800 gm, case of 6, 300 gal.* IMS-1230C $ 214.50 $ 160.90 $ 160.90
Enzymax Pax, 32 Powder Packets, 32 gal.* IMS-1232 $ 46.45 $ 34.85 $ 34.85
Enzymax Pax Powder Packets, 96 gal.* IMS-1233 $ 118.50 $ 88.90 $ 88.90
DAILY CLEAN GENERAL PURPOSE DETERGENT
IMS ® Daily Clean, 5LB/2.27kg Tub, 160 gal.*
INSTRUMENT LUBRICANTS
IMS-1218 $ 83.75 $ 62.80 $ 62.80
High Heat Instrument Lubricant, 8oz Pump ILHH $ 27.10 $ 20.35 $ 20.35
Instrument Lubricant, 8oz Pump ILS $ 17.35 $ 13.00 $ 13.00
Penetrating Oil, 8oz Pump IPS $ 17.35 $ 13.00 $ 13.00
(Category Annual Minimum $300)** Total Cleaning and Care
STERILIZATION SAVE 10 - 15%
I.D. LABELS SAVE 15%
Cassette I.D. Labels, 50 pack IMS-1234 $ 25.40 $ 21.60 $ 21.60
STEAM STERILIZATION INDICATORS SAVE 15%
Steam Sterilization Indicators, Box of 250 IMS-1240 $ 26.95 $ 22.90 $ 22.90
MONITOR TAPE SAVE 15%
Monitor Tape, Orthodontic, 60 yards/55m IMS-1243 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Archwire, 60 yards/55m IMS-1244 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Banding, 60 yards/55m IMS-1245 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Bonding, 60 yards/55m IMS-1246 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Restorative, 60 yards/55m IMS-1247 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Surgery, 60 yards/55m IMS-1248 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, X-Ray, 60 yards/55m IMS-1249 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Blank, 60 yards/55m IMS-1250 $ 9.80 $ 8.35 $ 8.35
Monitor Tape, Amalgam, 60 yards/55m IMS-1251 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, C & B, 60 yards/55m IMS-1252 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Cement, 60 yards/55m IMS-1253 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Composite, 60 yards/55m IMS-1254 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Endo, 60 yards/55m IMS-1255 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Exam, 60 yards/55m IMS-1256 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Extraction, 60 yards/55m IMS-1257 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Perio, 60 yards/55m IMS-1258 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Prophy, 60 yards/55m IMS-1259 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Pedo, 60 yards/55m IMS-1260 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Gray Stripe, 60 yards/55m IMS-1262 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Orange Stripe, 60 yards/55m IMS-1263 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Purple Stripe, 60 yards/55m IMS-1264 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Yellow Stripe, 60 yards/55m IMS-1265 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Red Stripe, 60 yards/55m IMS-1266 $ 16.70 $ 14.20 $ 14.20
Y N

ABC
Item Description Hu-Friedy Sugg. HUSAVE J F M A M J J A S O N D 12 Month HUSAVE Total
Part Code Retail Price Total Units Price 12 Month
Price (Jan–Dec) Purchases
STERILIZATION CONTINUED
MONITOR TAPE, CONTINUED SAVE 15%
Monitor Tape, Green Stripe, 60 yards/55m IMS-1267 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Blue Stripe, 60 yards/55m IMS-1268 $ 16.70 $ 14.20 $ 14.20
Monitor Tape, Black Stripe, 60 yards/55m IMS-1269 $ 16.70 $ 14.20 $ 14.20
IMS STERILIZATION WRAP SAVE 15%
24" x 24" Autoclave Wrap, 500 sheets IMS-1210 $ 166.50 $ 141.55 $ 141.55
15" x 15" Autoclave Wrap, 1000 sheets IMS-1211 $ 145.00 $ 123.25 $ 123.25
20" x 20" Autoclave Wrap, 500 sheets IMS-1212 $ 134.00 $ 113.90 $ 113.90
12" x 12" Autoclave Wrap, 1000 sheets IMS-1213 $ 104.50 $ 88.85 $ 88.85
24" x 24" Universal Wrap, 500 sheets IMS-1214 $ 138.50 $ 117.70 $ 117.70
15" x 15" Universal Wrap, 1000 sheets IMS-1215 $ 124.00 $ 105.40 $ 105.40
20" x 20" Universal Wrap, 500 sheets IMS-1216 $ 115.50 $ 98.15 $ 98.15
12" x 12" Universal Wrap, 1000 sheets IMS-1217 $ 97.00 $ 82.45 $ 82.45
BAG-ETTE SELF-SEALING STERILIZATION POUCHES SAVE 10%
IMS-1236 3 1/2” x 10” IMS-1236 $ 13.00 $ 11.70 $ 11.70
IMS-1237 7 1/8” x 13 13/16” IMS-1237 $ 19.00 $ 17.10 $ 17.10
IMS-1238 8 7/8” x 14 5/16” IMS-1238 $ 35.00 $ 31.50 $ 31.50
IMS-1239 11 5/8” x 17 5/16” IMS-1239 $ 47.00 $ 42.30 $ 42.30
(Category Annual Minimum $900)** Total Sterilization
DISPOSABLE INSTRUMENTS SAVE 20-50%
SCALPEL BLADES SAVE 50%
11 Carbon Scalpel Blade, Box of 100 10-255-11 $ 80.50 $ 42.25 $ 42.25
12 Carbon Scalpel Blade, Box of 100 10-255-12 $ 80.50 $ 42.25 $ 42.25
15 Carbon Scalpel Blade, Box of 100 10-255-15 $ 80.50 $ 42.25 $ 42.25
25 Carbon Scalpel Blade, Box of 100 10-255-25 $ 80.50 $ 42.25 $ 42.25
12D Carbon Scalpel Blade, Box of 100 10-256-12 $ 131.50 $ 64.25 $ 64.25
15C Carbon Scalpel Blade, Box of 100 10-256-15 $ 120.00 $ 58.75 $ 58.75
11 Stainless Scalpel Blade, Box of 100 40-811 $ 44.40 $ 22.20 $ 22.20
12 Stainless Scalpel Blade, Box of 100 40-812 $ 56.50 $ 27.65 $ 27.65
15 Stainless Scalpel Blade, Box of 100 40-815 $ 44.40 $ 22.20 $ 22.20
25 Stainless Scalpel Blade, Box of 100 40-825 $ 44.40 $ 22.20 $ 22.20
12D Stainless Scalpel Blade, Box of 100 40-812B $ 78.25 $ 39.15 $ 39.15
15C Stainless Scalpel Blade, Box of 100 40-815C $ 78.25 $ 39.15 $ 39.15
COLORVUE ® PROBES SAVE 25%
12 UNC Colorvue Kit, 2 Handles & 12 Tips PCVNCKIT12 $ 84.25 $ 63.20 $ 63.20
12 UNC Colorvue Kit, Handle & 6 Tips PCVNCKIT6 $ 51.50 $ 38.65 $ 38.65
UNC 12 Colorvue Tips, 12 pack PCVUNC12PT $ 68.50 $ 51.40 $ 51.40
Williams Colorvue Kit, Handle & 6 Tips PCVWKIT6 $ 51.50 $ 38.65 $ 38.65
Williams Colorvue Tips, 12 pack PCVWPT $ 68.50 $ 51.40 $ 51.40
11 Colorvue Kit, 2 Handles & 12 tips PCV11KIT12 $ 84.25 $ 63.20 $ 63.20
11 Colorvue Kit, Handle & 6 tips PCV11KIT6 $ 51.50 $ 38.65 $ 38.65
11 Colorvue Tips, 12 pack PCV11PT $ 68.50 $ 51.40 $ 51.40
12 Colorvue Kit, 2 Handles & 12 Tips PCV12KIT12 $ 84.25 $ 63.20 $ 63.20
12 Colorvue Kit, Handle & 6 Tips PCV12KIT6 $ 51.50 $ 38.65 $ 38.65
12 Colorvue Tips, 12 pack PCV12PT $ 68.50 $ 51.40 $ 51.40
IMPLACARE SCALERS SAVE 25%
4R/4L Implacare Tips, 10 pairs IC4R/4L $ 52.50 $ 39.40 $ 39.40
204S Implacare Tips, 10 pairs I204S $ 52.50 $ 39.40 $ 39.40
H6/7 Implacare Tips, 10 pairs IH6/7 $ 52.50 $ 39.40 $ 39.40
Assorted Implacare Tips, 12 pairs IMPA $ 52.50 $ 39.40 $ 39.40
Implacare Kit, Assorted Tips, Handle & 12 pairs IMPLACARA6 $ 66.00 $ 49.50 $ 49.50
Implacare Kit, 4R/4L Tips, Handle & 10 pairs IMPLACAR16 $ 66.00 $ 49.50 $ 49.50
Implacare Kit, 204S Tips, Handle & 10 pairs IMPLACAR26 $ 66.00 $ 49.50 $ 49.50
Implacare Kit, H6/7 Tips, Handle & 10 pairs IMPLACAR36 $ 66.00 $ 49.50 $ 49.50
PERMA SHARP SUTURES SAVE 20%
Chromic Gut
3-0 Chromic Gut 27", C-6 Needle PSN636C $ 51.00 $ 40.80 $ 40.80
4-0 Chromic Gut 18", C-3 Needle PSN1654C $ 114.50 $ 91.60 $ 91.60
4-0 Chromic Gut 27", C-6 Needle PSN635C $ 51.00 $ 40.80 $ 40.80
4-0 Chromic Gut 18", C-17 Needle PSN386C $ 51.00 $ 40.80 $ 40.80
5-0 Chromic Gut 18", C-3 Needle PSN687C $ 115.00 $ 92.00 $ 92.00
5-0 Chromic Gut 27", C-6 Needle PSN634C $ 51.00 $ 40.80 $ 40.80
5-0 Chromic Gut 18", C-17 Needle PSN385C $ 51.00 $ 40.80 $ 40.80
6-0 Chromic Gut 18", C-1 Needle PSN1816C $ 112.50 $ 90.00 $ 90.00
Plain Gut
3-0 Plain Gut 27", C-6 Needle PSNH822A $ 51.00 $ 40.80 $ 40.80
3-0 Plain Gut 27", C-7 Needle PSNH810A $ 51.00 $ 40.80 $ 40.80
3-0 Plain Gut 18", C-9 Needle PSN612A $ 51.00 $ 40.80 $ 40.80
4-0 Plain Gut 18", C-3 Needle PSN1644A $ 112.50 $ 90.00 $ 90.00
4-0 Plain Gut 18", C-6 Needle PSN7771A $ 51.00 $ 40.80 $ 40.80
4-0 Plain Gut 27", C-6 Needle PSNH821A $ 51.00 $ 40.80 $ 40.80
5-0 Plain Gut 18", C-3 Needle PSN686A $ 115.00 $ 92.00 $ 92.00
5-0 Plain Gut 18", C-19 Needle PSN723A $ 51.00 $ 40.80 $ 40.80
5-0 Plain Gut 27", C-6 Needle PSNH820A $ 51.00 $ 40.80 $ 40.80
6-0 Plain Gut 18", C-1 Needle PSN774A $ 112.50 $ 90.00 $ 90.00

Dealer Choice
(Must choose one dealer for entire calendar period)
Dealer Name
Dealer Address
City, State, Zip code
Dealer Representative
ABC
Price (Jan–Dec) Purchases
Item Description Hu-Friedy Sugg. HUSAVE J F M A M J J A S O N D 12 Month HUSAVE Total
Part Code Retail Price Total Units Price 12 Month
DISPOSABLE INSTRUMENTS CONTINUED
PGA Dyed
3-0 Violet PGA 27", C-9 Needle PSN460V $ 59.50 $ 47.60 $ 47.60
3-0 Violet PGA 18", C-6 Needle PSN393V $ 56.75 $ 45.40 $ 45.40
4-0 Violet PGA 18", C-6 Needle PSN392V $ 56.75 $ 45.40 $ 45.40
4-0 Violet PGA 27", C-6 Needle PSN397V $ 56.75 $ 45.40 $ 45.40
5-0 Violet PGA 18", C-22 Needle PSN388V $ 61.00 $ 48.80 $ 48.80
6-0 Violet PGA 18", C-22 Needle PSN387V $ 61.00 $ 48.80 $ 48.80
PGA Undyed
4-0 Undyed PGA 18", C-3 Needle PSN494V $ 124.50 $ 99.60 $ 99.60
4-0 Undyed PGA 27", C-6 Needle PSN422V $ 61.00 $ 48.80 $ 48.80
4-0 Undyed PGA 18", C-17 Needle PSN386V $ 61.00 $ 48.80 $ 48.80
5-0 Undyed PGA 18", C-17 Needle PSN385V $ 61.00 $ 48.80 $ 48.80
5-0 Undyed PGA 18", C-1 Needle PSN490V $ 124.50 $ 99.60 $ 99.60
5-0 Undyed PGA 18", C-3 Needle PSN493V $ 124.50 $ 99.60 $ 99.60
5-0 Undyed PGA 27", C-6 Needle PSN421V $ 61.00 $ 48.80 $ 48.80
5-0 Undyed PGA18", C-19 Needle PSN723V $ 61.00 $ 48.80 $ 48.80
6-0 Undyed PGA 18", C-1 Needle PSN489V $ 124.50 $ 99.60 $ 99.60
6-0 Undyed PGA 18", C-3 Needle PSN492V $ 124.50 $ 99.60 $ 99.60
Silk Braided
3-0 Black Silk 18", C-6 Needle PSN7772S $ 45.65 $ 36.50 $ 36.50
3-0 Black Silk 18", C-7 Needle PSN684S $ 45.65 $ 36.50 $ 36.50
3-0 Black Silk 18", C-9 Needle PSN632S $ 45.65 $ 36.50 $ 36.50
3-0 Black Silk 18", C-43 Needle PSN7762S $ 42.35 $ 33.90 $ 33.90
4-0 Black Silk 18", C-3 Needle PSN641S $ 108.50 $ 86.80 $ 86.80
4-0 Black Silk 18", C-6 Needle PSN683S $ 45.65 $ 36.50 $ 36.50
4-0 Black Silk 18", C-19 Needle PSN734S $ 45.65 $ 36.50 $ 36.50
4-0 Black Silk 18", C-17 Needle PSN736S $ 42.35 $ 33.90 $ 33.90
5-0 Black Silk 18", C-3 Needle PSN640S $ 110.00 $ 88.00 $ 88.00
5-0 Black Silk 18", C-6 Needle PSN682S $ 45.65 $ 36.50 $ 36.50
5-0 Black Silk 18", C-17 Needle PSN719S $ 46.15 $ 36.90 $ 36.90
6-0 Black Silk 18", C-22 Needle PSN681S $ 42.35 $ 33.90 $ 33.90
Polyester
4-0 Green Polyester 18", C-6 Needle PSNR683L $ 53.00 $ 42.40 $ 42.40
5-0 Green Polyester 18", D-14 Needle PSN7773L $ 97.75 $ 78.20 $ 78.20
Polypropylene
4-0 Blue Polypropylene 18", C-6 Needle PSN8683P $ 61.00 $ 48.80 $ 48.80
5-0 Blue Polypropylene 18", C-3 Needle PSN8698P $ 114.50 $ 91.60 $ 91.60
5-0 Blue Polypropylene 18", C-6 Needle PSN8661P $ 61.00 $ 48.80 $ 48.80
6-0 Blue Polypropylene 18", C-1 Needle PSN8697P $ 114.50 $ 91.60 $ 91.60
6-0 Blue Polypropylene 18", C-3 Needle PSN8695P $ 114.50 $ 91.60 $ 91.60
7-0 Blue Polypropylene 18", C-1 Needle PSN8696P $ 114.50 $ 91.60 $ 91.60
Nylon
5-0 Black Nylon 18", C-6 Needle PSN661N $ 46.65 $ 37.30 $ 37.30
4-0 Black Nylon 18", C-6 Needle PSN662N $ 46.65 $ 37.30 $ 37.30
Additional Disposable Instruments
For additional suture part codes please refer to the Hu-Friedy Suture Chart or call us at 1-866-HUSAVE3
(Category Annual Minimum $1,400)** Total Disposable Instruments
**HUSAVE pricing only valid if category annual minimum purchase is met. At the end of each calendar year, rebates are paid based on meeting yearly minimums per product category.
If you sign up during the course of the year, the minimum requirement will be pro-rated based on the date of initial shipment through the end of the calendar year.
All orders are subject to acceptance and approval by Hu-Friedy and the designated authorized Hu-Friedy dealer. HUSAVE program is valid in the U.S. only
and cannot be combined with any other program or promotional offers. Schools and institutional accounts are not eligible.
Prices and terms subject to change with 30-day written notice. Orders shipped F.O.B. Chicago and subject to shipping charges.
Hu-Friedy retains the right to modify or cancel at any time. May not change dealer choice during calender period.
There is no need for annual renewal. You will continue to receive your items per the schedule you have established without interruption, until cancelled or
modified. You may cancel or modify your HUSAVE order at any time by contacting Hu-Friedy in writing.
For your protection, cancellation or modification of your HUSAVE program can only be requested on office letterhead bearing an authorized signature.
DENTAL PROFESSIONAL’S SIGNATURE (Authorized Signor) Date
(Office Use Only)
Dealer P.O. #
Shipments will be sent during the first
business week of each month.
HF-295/5M/12-05