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7-Elastomerics.pfd - Fairfield Orthodontics

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FAIRFIELD ORTHODONTICSFax Order FormFax Toll-Free To:877-570-2844Bill To:NAME:ADDRESS 1:Ship To:NAME:ADDRESS 1:Same as Bill ToADDRESS 2:ADDRESS 2:CITY:PHONE:FAX:( )( )STATE:ZIP:CITY:PHONE:FAX:( )( )STATE:ZIP:Items Requested:Item # Qty Description SpecificationsShipping Options:All orders shipped DHL GroundService unless otherwise specified.DHL 2nd Day AirPayment Options:Bill Me Net 30 Days (Overdue Fees May Apply)Credit Card PaymentDHL Next Day Airother ______________Sign.Exp.FAIRFIELDORTHODONTICSToll Free 800-321-0331Free Fax 877-570-2844

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