Open an Account

Please complete the following details:

Name........................................................................

Address ...................................................................

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Tel No ......................................................................

Fax No ......................................................................

E-mail ......................................................................

Ref 1........................................................................

Address ...................................................................

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Tel No ......................................................................

Ref 2 ........................................................................

Address ...................................................................

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Tel No ......................................................................

Signature ......................................................................

Please print and post to:

Prestige Dental Products Ltd.

7 Oxford Place

Bradford

West Yorkshire

BD3 0EF

UK

Or fax to:

Fax: +44 (0)1274 304 237