Corporate Registration - Practical Implantology Shop

Corporate Dental Clients Registration Form

Once we verify your registration, your individual clinics can place orders without making payments online
On the CHECKOUT page there will be an option to pay by INVOICE
Invoices will be attached with orders as PDF
PAYMENT TERMS: Invoice payments are required within 30 days from the date of order

MAIN CORPORATE CONTACT DETAILS

Company Name

Company reg no.

How many Clinics

Title

First Name*

Surname*

Role

Email Address Admin*

Confirm Email AddressAdmin*

Billing Email Address*

Confirm Billing Email Address*

Mobile No.

Head Office Phone (work)

Head Office Address & Post Code

Your Query or Message

Once you press SUBMIT above – we will be in touch to confirm your registration if successful – thank you.

Headquarters: 020 3289 6229
Call Mukesh Soni: 07957 495 655
Call Sam Mohamed: 07703 736 814
Call Azhar Sheikh: 07722 418 931