Confirm Monitoring Systems, Inc.

ConFirm | SoftX Free Box Request Form

Complete the following form for a free box of SoftX with your order of 1 box.

Office Name:

Street Address:
(No PO Box)

City:

State:

Zip:

Phone:

My Dental Dealer:

Send me a FREE BWL252 (fits all Size 2 x-ray film) with my order of 1 box at $24.95/box of 250.
Send me a FREE BWL250 (fits all Size 0 x-ray film) with my order of 1 box at $24.95/box of 250.
Send me a FREE VBWL252 (fits Size 2 film for Vertical x-ray) with my order of 1 box at $24.95/box of 250.