North American Integrated Dental Society

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Member Financial Benefits

Darby Dental Supply would like to welcome you and invite you to become a member of the Darby benefits program through the North American Integrated Dental Society. As a member of this Darby program your dental office will realize the benefit of group purchasing.

· Save an average of 12 to 17 % off each order. Your representative will provide customized pricing.

Name of Dental Office:
Office Address:
City:	State:	Zip Code:
Primary Contact Name:		Phone:
Primary Contact E-mail Address:
Secondary Contact Name:			Phone:
Secondary Contact E-mail Address:
Are you currently a customer of Darby Dental?
If yes, what is your account number?

Please Print form, complete and Fax to: Tucker Craig

Darby Dental Supply Company

210-481-6873

Tucker.craig@darbydentalsupply.com

Darby Dental Supply, LLC 300 Jericho Quadrangle Jericho, NY 11753 Phone: 800.645.2310 Fax: 800.957.7362