3M ESPE Dental Professionals > Promotions > Requests
While supplies last!
Choose a free:
These trial packs are not for retail sale.
Choose 1 free trial pack:
Impregum™ Intra-oral Syringe Trial Pack (for Polyether) Contains 3 unfilled purple syringes (MSRP n/a)
Imprint™ 3 Intra-oral Syringe Trial Pack (for VPS) Contains 3 unfilled green syringes (MSRP n/a)
To place your order, please complete the following:
ALL FIELDS ARE REQUIRED
Business Name:
First Name:
Last Name:
National Provider Identifier (NPI) Number: (XXXXXXXXXX) 10 digits, no hyphens or spaces - this should be your individual NPI number, not your practice NPI number
Ship To Address - Sorry, we cannot ship to P.O. boxes.
Street:
City:
State: (Please Choose) Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip Code: (XXXXX) 5 digits, no hyphens or spaces
Business Phone: (XXXXXXXXXX) 10 digits, no hyphens or spaces
Email: (email@domain.com)
Confirm Your Email Address: (email@domain.com)
Where did you hear about this offer? Select one 3M ESPE Rep Dealer Rep Lab Trade Publication Ad E-mail Web Banner Ads Colleague/Friend Other
Please check here if you wish to receive future email communications about other products and promotions from 3M ESPE.
Limited to one free trial pack per customer.
Product will not be shipped to addresses outside of the United States.
Please allow 3-5 weeks for delivery of your free product.
3M ESPE reserves the right to discontinue or change these offers at any time. It is the doctor’s obligation to properly report and appropriately reflect any free product on their submissions to Medicare/Medicaid/private insurance.
This information will be used only to respond to your request and in accordance with 3M’s privacy policy found at www.3M.com/privacy.
Customer Care Center: 1-800-634-2249
3MESPE.com