America's largest denture repair service		 ORDER FORM Questions? 
1-888-349-6695
Complete order form and click print button to print out the form. Credit card information is optional we can obtain it over the phone once denture is recieved. Shipping is free with prepaid label. Overnight shipping is suggested. We ship back with free overnight mail.
Mail to: Denture Repair Lab | 1006 Charles St Ste 4 | N. Providence RI 02904    


First Name  Last Name    Phone   *
Address
City
Email  
          Money Order     
Credit Card # 

Signature:___________________________________________    
I have read and agree to the Denture Repair Lab Policy and authorize Denture repair Lab to charge my credit card for the services provided.

Glue Removal $29.00     Metal Reinforcement $29.00   Rebuild Gum Area w/ New Acrylic $169.00
1 Crack/Break/Fracture     $79.00
2 Cracks/Breaks/Fractures $115.00
3 Cracks/Breaks/Fractures $145.00		 Duplicate Denture $299 / Duplicate Partial $349.00
Professional Cleaning & Polishing $49.00
90 Day Warranty $45.00

Glue Removal $29.00     Metal Reinforcement $29.00  Rebuild Gum Area w/ New Acrylic $169.00
1 Tooth (you supply tooth) $75.00
2 Teeth (you supply teeth) $95.00
3 Teeth (you supply teeth) $115.00		 1 Tooth ( lab supply teeth) $95.00
2 Teeth (lab supply teeth) $125.00
3 Teeth (lab supply teeth) $165.00
Duplicate Denture $299 / Partial $349.00  Cleaning /Polishing $49.00 90 Day Warranty $45.00

Glue Removal $29.00     Metal Reinforcement $29.00
1 Crack/Break/Fracture $219.00
2 Cracks/Breaks/Fractures $259.00
 1 Tooth (you supply) $175.00
2 Teeth (you supply) $205.00
1 Tooth (lab supply) $195.00
2 Teeth (lab supply) $225.00
Duplicate Partial $349.00     Cleaning & Polishing $49.00   90 Day Warranty $75.00

Duplicate Denture  $299.00
Duplicate Partial (non metal) $349.00
Duplicate Hard Nightguard $199.00		 1Shade Whitter Teeth $35.00
Cleaning & Polishing $49.00
90 Day Warranty $45.00

Coupon Code
TOTAL
Additional Instructions
Please mail your denture to:
Denture Repair Lab
1006 Charles St Ste 4
North Providence RI 02904