DENTUREMART DENTUREMART - American Tooth Industries

Customize & Personalize SHADE GUIDE ORDER FORM
for Imperial Teeth
AMERICAN TOOTH INDUSTRIES
Customized Shade Guide Specifications
Customer Name ________________________________________ Account # ________________________________
Address: ______________________________________ City: __________________ State: ______ Zip: __________
Phone: _______________ Fax: ________________
P.O. # ___________________________________
5 1/2” Max. Print Area
COPY A
35 50 70 77 81 82 59 60 62 66 64 65 67 68 20 25 45 69
TM
®
FRONT
COPY A
SHADE SELECTOR
H.D. JUSTI CO.
BROWN WHITE YELLOW GRAY
1”
Max.
Print
Area
This shade guide is only available complete with 18 Imperial Shades. We customize only the front and back panel.
Shade System: Imperial (Bioform)
5 1/2” Max. Print Area
COPY B
US PAT 5,257,931
MADE IN U.S.A.
ITEM 084-51-0425
1”
Max.
Print
Area
BACK
COPY B
These artwork specifications are approved by a representative of our company:
______________________________________________________________
Please provide us with an artwork confirmation and complete quote (Proforma Invoice) for the lot to be manufactured
by American Tooth Industries on our behalf.*
__________________________________ __________________________
Name
Title
_______________________________________________ _____________
Company Name
Date
*For single order of customized shade guides, it is sufficient to fill out the ATI Standard Order Form signed by customer
in addition to this specification sheet.
Order Prepared By:
__________________________
Title: _____________________
Date: _____________
Approved By:
__________________________
ATI Officer
Date: __________
Form #292B - Rev. 6/05
www.americantooth.com 42
Be sure to mention promo code Holiday Specials to receive your discount.