P5 Newtron XS 14 Day Trial Online Request

This demo is authorized for a period of 14 days from the receipt of the unit.  The dealer of record is responsible for all shipping charges both to the recipient and back to ACTEON, Inc. and the unit shall be returned no later than 14 days after its receipt.  A dealer purchase order must be included to cover the shipping charges.  If the unit is not returned or purchased within 30 days, the dealer purchase order will be billed for the item's dealer price.  The replacement cost for any missing or damaged parts will also be billed to the dealer PO.  By submitting this request, you are agreeing to comply with the terms of this 14 Day Trial.

Dental Dealer Information

Please provide the following contact information:

Company Name  *  
Branch  *  
Dealer Rep Name  *  
Purchase Order #  *  
Street Address  *  
Address (cont.)    
City  *  
State  *  
Zip Code  *  
Dealer Phone  *  
Dealer FAX    
ACTEON Rep    

 

Dental Practice Information

Please provide the following contact information:

Practice Name  *  
First Name  *  
Last Name  *  
Street Address  *  
Address (cont.)    
City  *  
State  *  
Zip Code  *  
Practice Phone  *  
FAX    

SHIPPING OPTIONS

Choose one of the following options:

Ship to Dealer
Ship to Dentist

If a dealer PO is available in electronic form, please email a copy to info@us.acteongroup.com   Otherwise, please fax a copy to 856-222-4726.  Please be advised that no 14 Day Trial will be shipped without prior receipt of a dealer PO.

By submitting this form, you are agreeing to comply with these terms.

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Revised: 01/20/10