ICCARE - Subscription Plans

Call Toll-Free:
877- 477- 5486

Monday - Friday
6:30am - 4:30pm PST
Fax 877-477-5186
iccare@iccare.net

For Dealers

If you are a representative from a dental dealer and would like to place an order, please complete the order form.

1 Year X-Ray Monitoring Badges... As low as 37¢ day per person

	Quarterly Frequency 1 Badge and 1 Report per Quarter (4/yr)
	Monthly Frequency 1 Badge and 1 Report per Quarter (12/yr)
	Fetal Monthly Frequency 1 Badge and 1 Report per Month for 7 Months

	CPR™ Cosmetic Polishing Restorative 100/jar	Qty
	Diamond Glaze Polish	Qty
	Rad Badge™ High Tech USB Radiation Reader Badge 1 Year USB X-Ray Monitoring Service: Immediate dose report access from your computer, at your convenience, any time, no more shipping.	Qty
	Formaldehyde Vapor Monitoring Badge	Qty
	Glutaraldehyde Vapor Monitoring Badge	Qty
	Mercury Vapor Monitoring Badge	Qty
	Nitrous Oxide Vapor Monitoring Badge	Qty

Dealer / Rep. Name
Dealer / Rep email		(e-mail necessary for order confirmation)
Rep / PO #:
	Shipping Address
DR.
Address
City
ST
ZIP
Phone
Fax
Email

PLEASE PROVIDE BADGES FOR THESE EMPLOYEES PRINT FIRST, MIDDLE & LAST NAME
1
2
3
4
5

	Send these badges ASAP for this quarter
	Send badges beginning next quarter
	* orders placed after 6th week of calander quarter will be shipped the next calander quarter
As REP / DEALER, by submitting this form you hereby authorize ICCARE to process your order.

If you are a REP/DEALER and would like to fax your order please print the attached form
and fax it to 877-477-5186

Terms & Conditions