Special Offer on RelyX™ Ultimate Trial Kits and Refills

Buy 1 Trial Kit, Get 1 Refill FREE
- OR –
Buy 3 Refills, Get 1 Refill FREE

While quantities last.

Choose your special offer:

Buy 1 RelyX Ultimate Trial Kit, Get 1 Refill Free

Trial Kit Contains: 1- 8.5 gm syringe cement, 1 - 1.5 ml bottle of Scotchbond™ Universal Adhesive, 1 - 3 ml etchant syringe, 25 dispensing tips for etchant syringe, 50 microbrushes, 10 mixing tips (regular), 5 mixing tips (wide) + 5 intra-oral tips, Step-by-Step Technique Guide, Instructions for Use. (MSRP=$204.99)

Choose a shade:
A1
Translucent

Choose your free refill:
Refills Contain: 1 - 8.5 gm syringe cement, 10 mixing tips (regular), 5 mixing tips (wide) + 5 intra-oral tips, Instructions for Use. (MSRP= $172.50)
A1
A30 Opaque
B0.5 Bleach
Translucent

Buy 3 RelyX Ultimate Refills, Get 1 Refill Free

Refills Contain: 1 - 8.5 gm syringe cement, 10 mixing tips (regular), 5 mixing tips (wide) + 5 intra-oral tips, Instructions for Use. (MSRP= $172.50)

Choose 3 shades:
A1
A30 Opaque
B0.5 Bleach
Translucent

Choose your free refill:
A1
A30 Opaque
B0.5 Bleach
Translucent

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:

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)

Choose a distributor:

I am aware that my dental supplier will bill my account for this purchase.

Please check here if you wish to receive future email communications about other products and promotions from 3M ESPE.

Limited to one offer per customer. Offer expires December 31, 2012.

Product will not be shipped to addresses outside of the United States.

Your order will be placed, shipped and billed through the distributor of your choice. The order will arrive from the distributor in 2-5 days, depending on the distributor. 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

www.3MESPE.com/us