Fax: 1-203-773-9832
Phone: 1-800-246-YALE (9253)
375 Orange Street
New Haven, Connecticut 06511
Web Site: www.moyaledental.com
E-mail: moyaledentalinc@yahoo.com

New Instrument Order Form
Bill / Ship To:
Dr:
Address:
City: State: Zip:
Contact Person:
Telephone #: Fax #:
E-mail address:
VISA    |  MC   |  AMEX | CHECK   (payable to: "The Moyale")
 Card #:  
                               
  Exp. Date:  
   
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  Scalers and Curettes (Please specify handle size)
Product # Description Price
Quantity
Extended
44-30
1-2 Gracey Curette $17.49   $
44-32
3-4 Gracey Curette $17.49   $
44-34
5-6 Gracey Curette $17.49   $
44-36
7-8 Gracey Curette $17.49   $
44-38
9-10 Gracey Curette $17.49   $
44-40 11-12 Gracey Curette $17.49   $
44-42 13-14 Gracey Curette $17.49   $
44-44 4L-4R Columbia Curette $17.49   $
44-46 13-14 Columbia Curette $17.49   $
44-48 2L-2R Columbia Curette $17.49   $
44-50 13-14 McCalls Curette $17.49   $
44-52 13S-14S McCalls Curette $17.49   $
44-54 17-18 McCalls Curette $17.49   $
44-56 17S-18S McCalls Curette $17.49   $
44-92 1Y-1Y Double Ended Scaler $17.49   $
44-94 1Y-1YS Double Ended Scaler $17.49   $
44-96 2Y-3Y Double Ended Scaler $17.49   $
44-98 2YS-3YS Double Ended Scaler $17.49   $
44-100 2-3 Double Ended Jaquette Scaler $17.49   $
44-102 Jacquette Scaler 2S-3S $17.49   $
44-112 204S Scaler $17.49   $
44-114 7-8 Younger/Good Scaler $17.49   $
44-120 U15-30 Scaler $17.49   $
44-122 U15-33 Scaler $17.49   $
44-124 H5-33 Scaler $17.49   $
44-126 H6-7 Scaler $17.49   $
 

 
  Montana Jack & Cruise Line Instruments
Product # Description Price
Quantity
Extended
  Montana Jack
R138 MTJ - Montana Jack - Double Ended scaler $21.99   $
  Explorers Singled Ended
R183
SE EX-23 Explorer - Single Ended $21.99   $
  Explorers Double Ended
R166
DE EX-5 $21.99   $
R167 DE EX-11-12 $21.99   $
R168 DE EX-2 $21.99   $
  Explorer / Black Probe Combination
R223 23/12 $21.99   $
R224 23/OW $21.99   $
R225 23/WHO $21.99    $
  Black Probes - Single Ended
R195 PR-12 $21.99   $
R196 PR-OW $21.99   $
R197 PR-WHO $21.99   $
R199 PR-UNCI5 $21.99   $
   Curettes
R001 Gracey 00 $21.99   $
R016 Gracey 1-2 $21.99    $
R018 Gracey 3-4 $21.99    $
R020 Gracey 5-6 $21.99    $
R022 Gracey 7-8 $21.99    $
R024 Gracey 9-10 $21.99   $
R026 Gracey 11-12 $21.99   $
R028 Gracey 13-14 $21.99   $
R030 Gracey 15-16 $21.99   $
R032 Gracey 17-18 $21.99   $
R034 Gracey 11-14 $21.99   $
R036 Gracey 12-13 $21.99   $
R042 Gracey 11-12 ER $21.99   $
R043 Gracey 13-14 ER $21.99   $
R060 Barnhart 1-2 $21.99   $
R061 Barnhart 5-6 $21.99   $
R076 Rules 3-4 $21.99   $
R077 Younger-Good YG 7-8 $21.99   $
R069 McCalls 13-14 $21.99   $
R070 McCalls 13-14S $21.99   $
R071 McCalls 17-18 $21.99   $
R072 McCalls 17-18S $21.99   $
R064 Columbia 13-14 $21.99   $
R067 Columbia 4L-4R $21.99   $
R079 Langer 1-2 $21.99   $
R080 Langer 3-4 $21.99   $
R081 Langer 5-6 $21.99   $
  Mirror - Handles
T050 MIR - # 5 $4.00   $
T051 MIR - # 4 $4.00   $
R245 MH Mirror Handle $11.99   $
  Scalers - Double Ended
R110 H 6-7 $21.99    $
R111 H 5-33 $21.99    $
R113 U 15-33 $21.99    $
R114 NEB-128 $21.99   $
R115 NEB-128-33 $21.99   $
R090 HL 5-5 Scaler/Curette Combo $21.99   $
R135 204 S $21.99   $
R136 204 SD $21.99   $
 

 
 
Ultrasonic Inserts
 
Description
Price  Quantity  Extended
 
25K-DP#10 Universal
$105.00     $
 
25K-DP#100 Sraight
$105.00    $
 
25K-DP#100 Right
$105.00    $
 
25K-DP#100 Left
$105.00    $
 
30K-DP#10 Universal
$105.00    $
 
30K-DP#100 Straight
$105.00    $
 
30K-DP#100 Right
$105.00    $
 
30K-DP#100 Left
$105.00    $
 
25K-DP#10 Universal - Rebuilt
$75.00    $
 
25K-DP#100 Sraight - Rebuilt
$75.00    $
 
25K-DP#100 Right - Rebuilt
$75.00    $
 
25K-DP#100 Left - Rebuilt
$75.00    $
 
30K-DP#10 Universal - Rebuilt
$75.00    $
 
30K-DP#100 Straight - Rebuilt
$75.00    $
 
30K-DP#100 Right - Rebuilt
$75.00    $
 
30K-DP#100 Left - Rebuilt
$75.00    $
 
25K-DF3
$85.00    $
  
25K-DF10
$85.00    $
 
25K-DF1000
$85.00    $
 
30K-DF3
$85.00    $
 
30K-DF10
$85.00    $
 
30K-DF1000
$85.00    $
 
New 25K Slimline DF100
$105.00    $
 
New 30K Slimline DF100
$105.00    $
 
 
Crown Remover
 
Christensen Crown Remover
$45.00   $
 
  Toothbrushes (Priced per case, 144 pieces)
Product # Description Price/Cs Quantity Extended
3704 Adult Classic Soft $84.96    
3704 I Adult Classic Interdental    $84.96    
0701 Perio End Tuft $84.96    
2705 Youth ExtraSoft $84.96    
  Super Saver Toothbrushes
7527 Compact $70.56    
7532 Adult      $70.56    
7538 Youth $70.56    
7539 Kids $70.56    
  Toothbrush Imprinting (Per 144 piece case, minimum 4 case order)
  Description Price/Cs Quantity Extended
  Imprint up to 26 characters $18.75    
   IMPRINT:    
         
        
  Disposable Prophy Angles
247-144 Soft Green - 144 count $42.50    
248-144 Firm White - 144 count $42.50    
247-500 Soft Green - 500 count $150.00    
248-144 Firm White - 500 count $150.00     
         

  
 TOTAL AMOUNT OF ORDER:
 $
  
 SHIPPING/HANDLING:
0-60   instruments...$10.25
                                 61-80  instruments...$12.25
                                81-100 instruments...$14.25
 $                     
 
TOTAL
 $


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