Dealership Inquiry


Most of our products are distributed through dental Distributors. If you are a U.S. Distributor and interested in distributing our products, please fill out the Prospective Dealer Profile Form below and return it to us. If you are a qualified distributor, we will provide pricing and product information to you.

If you are an international distributor, please email us at email@applied-dental.com. We will reply to your inquiry ASAP.

Prospective Distributor Profile Form

Company Name:  
Address:  
City:  
State/Postal code/Country:  
Phone:  
Fax:  
E-mail Address:  
Contact Person/Buyer:  
Years Established:  
Total # of Employees:  
Re-sale Certificate #:  
Geographic Area Covered:  
Business References/Tel, #1:  
#2:  
#3:  
Types of Products currently distributed:  
ADI products you are interested in distributing:  
Freight Choices:  UPS Fedex
Samples interested:  



©2007 Applied Dental Inc. All Rights Reserved

465 Fairchild Drive, Suite 202, Mountain View, CA 94043 U.S.A.
Tel: 888-841-8481 / 650-960-0313, Fax: 650-960-0380, Email: email@applied-dental.com
www.applied-dental.com, www.ezstent.com

O-Pak | Thermoplastic Template Drill Set | Biggie Tooth Model | I-Pak | Easy Syringe | Intra-oral Tips |
Dandy | Easy Cord | H-Pak | Interdental Brush System | J-Pak |
About Us | Contact Us | Shopping Cart | Policies | U.S. Distributor List | Dealership Inquiry