Order Form
Order Form
Firm Name *

Customer Representative *

Termin *

Place of use *

Date requested*

Ribbon Color Approval *    Yes    No

Contrast Color *    Yes    No

Wash *    Yes    No

Ultrasound Film *    Yes    No

Gland Film *    Yes    No

Series
Type
Genus(M-N-K)
DP-SP-KM-0-X-İLMİK
Size (CM)
Ribbon Color
Amount(total-MTR)
Tooth Color
Client Order / Stle No.
1
2
3
4
5
6
7
8
9
10

Will text cursor without *    Yes    No

Bottom Cursor Code *

Top Cursor Code *

Cursor Color Covering *

Bottom Puller Code *

Üst Puller Code *

Puller Covering *

Box Written/UnWritten*    Yes    No

Box Pim Covering *

Bottom Stop*    Film    Plastic    Rice    Oxide    Aluminum

Top Stop*    Film    Plastic    Rice    Oxide    Aluminum

Explanations *

  

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