Order Information
Phone: (888) 411-6933
Mail:  Send this form and handpiece to WISE DENTAL REPAIR, 2816 WATERLOO RD MOGADORE, OHIO 44260

Terms & Conditions
If your handpiece requires one of these repairs (at your request), then we will complete the repair and send your handpiece back to you. If your handpiece requires any other work, we will contact you before any work begins. Satisfaction is guaranteed!

Shipping Information
Enclose your handpiece in a box or padded mailing envelope, along with the completed form below. Please cut out our prepaid mailing label below and affix it to your box

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Shipping Address

Name
Address
City		State
Country		Zip
E-mail
Phone

Include description of problem, or work to be performed.

Billing Information

Credit card
Name on Card
Card number
Expiration

Master card, Visa, American Express accepted