Order Form

NEED TELEPHONE SUPPORT? CALL (800) LIFE-LIKE (800-543-3545)

Ordering Information

You must be ordering this material for a licensed dental practice. For information on how to get your teeth bleached visit our Patient Corner. For pricing information, contact us.

  • At-Home Whitening Kits

  • Please enter a value between 0 and 50.
    Item number: 5030
  • Please enter a value between 0 and 50.
    Item number: 5040
  • Item number: 5050
  • Item number: 5070

  • At-Home Whitening Mini-Kits

  • Please enter a value between 0 and 50.
    Item number: 5230
  • Please enter a value between 0 and 50.
    Item number: 5240
  • Please enter a value between 0 and 50.
    Item number: 5250
  • Please enter a value between 0 and 50.
    Item number: 5270

  • At-Home Whitening Bulk Syringes

  • Please enter a value between 0 and 50.
    Item number: 5130
  • Please enter a value between 0 and 50.
    Item number: 5140
  • Item number: 5150
  • Please enter a value between 0 and 50.
    Item number: 5170

  • Standard Bottled Gel

  • Please enter a value between 0 and 50.
    Item number: 7010
  • Item number: 7020
  • Please enter a value between 0 and 50.
    Item number: 7030
  • Please enter a value between 0 and 50.
    Item number: 7110

  • In-Office Bleaching Material

  • Please enter a value between 0 and 50.
    Item number: 8000
  • Please enter a value between 0 and 50.
    Item number: 8020
  • Please enter a value between 0 and 50.
    Item number: 8035
  • Please enter a value between 0 and 50.
    Item number: 8050
  • Please enter a value between 0 and 50.
    Item number: 8085

  • Support Materials

  • Please enter a value between 0 and 50.
    Item number: 6020
  • Please enter a value between 0 and 50.
    Item number: 6030
  • Please enter a value between 0 and 50.
    Item number: 6040
  • Please enter a value between 0 and 50.
    Item number: 6050
  • Please enter a value between 0 and 50.
    Item number: 6070
  • Please enter a value between 0 and 50.
    Item number: 6090
  • Please enter a value between 0 and 50.
    Item number: 6110
  • Please enter a value between 0 and 50.
    Item number: 8095

  • Marketing Materials

  • Please enter a value between 0 and 50.
    Item number: 9015
  • Please enter a value between 0 and 50.
    Item number: 9040
  • Please enter a value between 0 and 50.
    Item number: 9060
  • Please enter a value between 0 and 50.
    Item number: 9080
  • Please enter a value between 0 and 50.
    Item number: 9081
  • Please enter a value between 0 and 50.
    Item number: 9082
  • Please enter a value between 0 and 50.
    Item number: 9085
  • Please enter a value between 0 and 50.
    Item number: 9090
  • Please enter a value between 0 and 50.
    Item number: 9100
  • Please enter a value between 0 and 50.
    Item number: 9110
  • Please enter a value between 0 and 50.
    Item number: 9111
  • Please enter a value between 0 and 50.
    Item number: 9112

  • Additional Information

We will call you, verify your order, and establish your payment method over the phone. We accept Visa, American Express, Mastercard, and COD.

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