Membership is FREE

On behalf of all of us at Synergy Dental Partners, we would like to say welcome to our firm.

Our Group Purchasing Membership is completely FREE and allows your dental office to realize the benefits of group purchasing immediately. As a member of Synergy, your office will benefit from cost saving agreements made between Synergy and respective distributors and vendors.

Please fill out the web form below or print and fill out the .PDF form and fax to (888) 487-9791 or e-mail to sales@thesynergydentalpartners.com so that we can start achieving savings for your office immediately.

Name of Dental Office*

Doctor's Name*

Prefix First Last

Dental License Number*

Office Address*

Street Address Address Line 2 City State ZIP Code

Primary Contact Name*

First Last

Primary Contact Email*

Primary Phone*

Will the Primary Contact also be ordering supplies?*

Yes
No

Name of Person Ordering Supplies*

First Last

Phone of Person Ordering Supplies*

Email of Person Ordering Supplies*

Fax Number

Are you currently a customer of Darby Dental?*

Darby Account Number

How did you hear about Synergy Dental Partners?*

Questions/Comments:

*

I have read the disclosure agreement:

Disclosure Agreement

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Membership is FREE

Membership Application

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