DENTAL LABORATORY REGISTRATION

DENTAL LAB NAME: *
LOCATION: *
CONTACT PERSON: *
CONTACT CELL #: *
CONTACT EMAIL: *
Name of your SiOS rep: *
Name on card: *
Address of card: *
Your signature *
Enter card number *
MM/YY *
CVC/CVV *
card holder name *
The package price of the Laboratory kit: $149,999 *

(Pre Order VIP Special: $129,999 thru Feb 28,2025)

You are authorized by company to engage in this transaction on behalf of your company. *

The SiOS™ package deposit is fully refundable. Expected commencement of delivery/install will be Q3/4 of 2025. Educational training course dates are being set up in specific locations throughout the U.S. Any refund request must be submitted in writing by email *within the specified 90-day period since submission to: Before the end of 2025 or manufacturer install date is confirmed.

*Pricing subject to change based on market availability & equipment from different manufacturers