Please see important instructions below order form before sending your order.

Printable Work Order
Please Print Clearly
Dr's Name:	__________________________
Address:	___________________________
City_________________St_____Zip_________
Phone:	__(___)_____-_________
Is this the Billing Address for the order?
YES		NO
Is this the Mailing Address for the order?
YES		NO
Patient's Name:	__________________________

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Mail completed order form to:
American Orthodontic Lab
17527 Little Mountain Pl.
Mount Vernon, Wa. 98274
(360) 422-6511


*Important Note*
If you are sending impressions with your order, please fill void with
wet cotton rolls to help hold alginate to trays.
Cover impressions with very wet paper towels and seal
in a zip lock type bag.


*Shipping Charges*
All orders over $50 will receive FREE shipping. All other orders will be charged a flat fee of $6 for shipping. Orders will be shipped via USPS Priority Mail.


*Payment*
An invoice will be sent to the billing address and will be due within 15 days.
Please make sure you indicate the correct billing address above on the order form. Thanks!