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Order Form – Supplementary Materials – Wiedent sp. j. Obywatelska 187/189, 94-104 Łódź
Date of completion:

Company *

Tax identification number *

E-mail *

Phone *

ESTETIC – heat-curing acrylic resin for denture bases

veined “10V”	(2000 g / 1000 ml)	(500 g / 250 ml)	(2000 g)	(500 g)
veined “8V”	(2000 g / 1000 ml)	(500 g / 250 ml)	(2000 g)	(500 g)
“10”	(2000 g / 1000 ml)	(500 g / 250 ml)	(2000 g)	(500 g)
“8”	(2000 g / 1000 ml)	(500 g / 250 ml)	(2000 g)	(500 g)
clear “0”	(2000 g / 1000 ml)	(500 g / 250 ml)	(2000 g)	(500 g)
liquid	(1000 ml)	(250 ml)

ESTETIC S – self-curing acrylic resin for denture repairs and orthodontic bases

veined “10V”	(500 g / 250 ml)	(100 g / 50 ml)	(500 g)	(100 g)
veined “8V”	(500 g / 250 ml)	(100 g / 50 ml)	(500 g)	(100 g)
“10”	(500 g / 250 ml)	(100 g / 50 ml)	(500 g)	(100 g)
“8”	(500 g / 250 ml)	(100 g / 50 ml)	(500 g)	(100 g)
clear “0”	(500 g / 250 ml)	(100 g / 50 ml)	(500 g)	(100 g)
liquid	(250 ml)	(50 ml)

ESTETIC Ort – colourless self-curing acrylic resin for orthodontic bases

clear “0”	(2000 g / 1000 ml)		(500 g / 250 ml)		(2000 g)
liquid	(1000 ml)		(250 ml)		(Estetic Ort colour 12.5 × 4 ml)

ESTETIC H – heat-curing acrylic resin for crowns and bridges (100 g / 50 ml)

liquid

A1V

A2V

A3V

A3.5V

A4V

B1V

B2V

B3V

B4V

C1V

C2V

C3V

C4V

D2V

D3V

ESTETIC SPECIAL – self-curing acrylic resin for temporary crowns and bridges (100 g / 50 ml)

A1V

A2V

A3V

A4V

B2V

C2V

D3V

liquid

Hard modelling wax

Soft modelling wax

Wax bite rims

Occlusal plate wax

Acrylic and wax materials are Class I medical devices registered in the Eudamed database; manufacturer's SRN: PL-MF-000029797.

Shade guide W	Shade guide V	Polishing paste – Reflex
Live mould chart – Estetic	Live mould chart – Almamiss	Live mould chart – Classic
Textile brush Ø 11 – metal	Textile brush Ø 8 – metal	Textile brush Ø 6 – metal
Textile brush Ø 11 – plastic	Textile brush Ø 8 – plastic	Textile brush Ø 6 – plastic
Textile-bristle brush – single Ø 8.8	Textile-bristle brush – double Ø 8.8

Acrylic and wax materials are Class I medical devices registered in the Eudamed database; manufacturer's SRN: PL-MF-000029797.

Order fulfilled on: ___________________ Signature of person fulfilling the order: ________________________ D 4026-14

Enter quantities from 1 to 999. Use the Tab key to move between fields.

After completing the form, save the filled-in form as an HTML file or choose Print / Save as PDF.

To send your order by e-mail, attach the saved HTML or PDF file to a message addressed to office@wiedent.com.pl.

Submitting this form constitutes placing an order. The fulfilment time depends on settlement of any outstanding payments. Fields marked * are required.