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    <a 


	href="https://dental.draft.webcart.us/impression-materials/" 


     role="button" role="button" title="Impression Material"
    
    
        class="nav-link"
    
    >Impression Material</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/impression-trays/" 


     role="button" role="button" title="Impression Trays"
    
    
        class="nav-link"
    
    >Impression Trays</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/infection-control/" 


     role="button" role="button" title="Infection Control"
    
    
        class="nav-link"
    
    >Infection Control</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/dental-laboratory/" 


     role="button" role="button" title="Laboratory"
    
    
        class="nav-link"
    
    >Laboratory</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/matrix-materials/" 


     role="button" role="button" title="Matrix"
    
    
        class="nav-link"
    
    >Matrix</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/pins-posts/" 


     role="button" role="button" title="Pins & Post"
    
    
        class="nav-link"
    
    >Pins & Post</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/preventives/" 


     role="button" role="button" title="Preventive products"
    
    
        class="nav-link"
    
    >Preventive products</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/dental-supplies-prophy-products/" 


     role="button" role="button" title="Prophy Products"
    
    
        class="nav-link"
    
    >Prophy Products</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/retraction-material/" 


     role="button" role="button" title="Retraction Material"
    
    
        class="nav-link"
    
    >Retraction Material</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/rubber-dam/" 


     role="button" role="button" title="Rubber Dam"
    
    
        class="nav-link"
    
    >Rubber Dam</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/splint-material-reinforcement/" 


     role="button" role="button" title="Splint Reinforcement "
    
    
        class="nav-link"
    
    >Splint Reinforcement </a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/suture-material/" 


     role="button" role="button" title="Sutures"
    
    
        class="nav-link"
    
    >Sutures</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/bleaching-whitening/" 


     role="button" role="button" title="Tooth Whitening"
    
    
        class="nav-link"
    
    >Tooth Whitening</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/toys/" 


     role="button" role="button" title="Toys"
    
    
        class="nav-link"
    
    >Toys</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ultrasonic-cleaners/" 


     role="button" role="button" title="Ultrasonic Cleaners"
    
    
        class="nav-link"
    
    >Ultrasonic Cleaners</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/dental-supplies-waste-management/" 


     role="button" role="button" title="Waste Management"
    
    
        class="nav-link"
    
    >Waste Management</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/water-treatment/" 


     role="button" role="button" title="Water Treatment"
    
    
        class="nav-link"
    
    >Water Treatment</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/waxes/" 


     role="button" role="button" title="Waxes"
    
    
        class="nav-link"
    
    >Waxes</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/dental-x-ray/" 


     role="button" role="button" title="X-Rays"
    
    
        class="nav-link"
    
    >X-Rays</a>

  
</li>
    </ul>
    
</li>
<li class="nav-item dropdown cats nav-item-dental-equipment 
 ">
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     title="Dental Equipment"
    
        class=" dropdown-toggle lav1item" role="button" data-bs-toggle="dropdown" aria-expanded="false"
    
    
     >Dental Equipment</a>
                
    
      <ul class="dropdown-menu lav1 dropdown-menu_dental-equipment">
        <li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ultrasonic-scalers/" 


     role="button" role="button" title="Ultrasonic Scalers"
    
    
        class="nav-link"
    
    >Ultrasonic Scalers</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/caries-detection/" 


     role="button" role="button" title="Caries Detection"
    
    
        class="nav-link"
    
    >Caries Detection</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/digital-processors/" 


     role="button" role="button" title="Digital Processors"
    
    
        class="nav-link"
    
    >Digital Processors</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/intra-oral-camera-parts/" 


     role="button" role="button" title="Intra-Oral Camera & Parts"
    
    
        class="nav-link"
    
    >Intra-Oral Camera & Parts</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/intra-oral-x-rays/" 


     role="button" role="button" title="Digital Sensors & X-ray Units "
    
    
        class="nav-link"
    
    >Digital Sensors & X-ray Units </a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/sterilizers/" 


     role="button" role="button" title="Sterilizers"
    
    
        class="nav-link"
    
    >Sterilizers</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/vacuums-parts/" 


     role="button" role="button" title="Vacuums & Parts"
    
    
        class="nav-link"
    
    >Vacuums & Parts</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/compressors/" 


     role="button" role="button" title="Compressors & Parts"
    
    
        class="nav-link"
    
    >Compressors & Parts</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/film-processors/" 


     role="button" role="button" title="Film Processors"
    
    
        class="nav-link"
    
    >Film Processors</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/operatory-chairs/" 


     role="button" role="button" title="Operatory Equipment"
    
    
        class="nav-link"
    
    >Operatory Equipment</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/hand-pieces/" 


     role="button" role="button" title="Handpieces"
    
    
        class="nav-link"
    
    >Handpieces</a>

  
</li>
    </ul>
    
</li>
<li class="nav-item dropdown cats nav-item-pharmaceuticals 
 ">
    <a href="https://dental.draft.webcart.us/pharmaceuticals/"
     title="Pharmaceuticals"
    
        class=" dropdown-toggle lav1item" role="button" data-bs-toggle="dropdown" aria-expanded="false"
    
    
     >Pharmaceuticals</a>
                
    
      <ul class="dropdown-menu lav1 dropdown-menu_pharmaceuticals">
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  ">


    <a 


	href="https://dental.draft.webcart.us/anti-inflammatory/" 


     role="button" role="button" title="Anti inflammatory"
    
    
        class="nav-link"
    
    >Anti inflammatory</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/antibiotics/" 


     role="button" role="button" title="Antibiotics"
    
    
        class="nav-link"
    
    >Antibiotics</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/antihistamine/" 


     role="button" role="button" title="Antihistamine"
    
    
        class="nav-link"
    
    >Antihistamine</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/beta-blocker/" 


     role="button" role="button" title="Beta Blocker"
    
    
        class="nav-link"
    
    >Beta Blocker</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/bronchodilator/" 


     role="button" role="button" title="Bronchodilator"
    
    
        class="nav-link"
    
    >Bronchodilator</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/vasoconstrictor/" 


     role="button" role="button" title="Vasoconstrictor"
    
    
        class="nav-link"
    
    >Vasoconstrictor</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/vasodilator/" 


     role="button" role="button" title="Vasodilator"
    
    
        class="nav-link"
    
    >Vasodilator</a>

  
</li>
    </ul>
    
</li>
<li class="nav-item dropdown cats nav-item-orthodontics 
 ">
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     title="Ortho"
    
        class=" dropdown-toggle lav1item" role="button" data-bs-toggle="dropdown" aria-expanded="false"
    
    
     >Ortho</a>
                
    
      <ul class="dropdown-menu lav1 dropdown-menu_orthodontics">
        <li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/denture-retainer-boxes/" 


     role="button" role="button" title="Ortho Denture & Retainer Boxes "
    
    
        class="nav-link"
    
    >Ortho Denture & Retainer Boxes </a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-bonding-supplies/" 


     role="button" role="button" title="Bonding Cements"
    
    
        class="nav-link"
    
    >Bonding Cements</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-brackets/" 


     role="button" role="button" title="Brackets"
    
    
        class="nav-link"
    
    >Brackets</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-elastomeric-products/" 


     role="button" role="button" title="Elastomeric Products"
    
    
        class="nav-link"
    
    >Elastomeric Products</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


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	href="https://dental.draft.webcart.us/ortho-fixed-appliances/" 


     role="button" role="button" title="Attachments "
    
    
        class="nav-link"
    
    >Attachments </a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/ortho-headgear/" 


     role="button" role="button" title="Headgear"
    
    
        class="nav-link"
    
    >Headgear</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-miscellaneous-supplies/" 


     role="button" role="button" title="Accessories"
    
    
        class="nav-link"
    
    >Accessories</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-molar-bands-tubes/" 


     role="button" role="button" title="Molar Bands & Tubes"
    
    
        class="nav-link"
    
    >Molar Bands & Tubes</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-patient-care-products/" 


     role="button" role="button" title="Patient Care Products"
    
    
        class="nav-link"
    
    >Patient Care Products</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/ortho-photo-mirrors/" 


     role="button" role="button" title="Photo Mirrors & Cheek Retractors "
    
    
        class="nav-link"
    
    >Photo Mirrors & Cheek Retractors </a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/ortho-wire-products/" 


     role="button" role="button" title="Wire Products"
    
    
        class="nav-link"
    
    >Wire Products</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/ortho-instruments/" 


     role="button" role="button" title="Instruments"
    
    
        class="nav-link"
    
    >Instruments</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/space-maintainers/" 


     role="button" role="button" title="Space Maintainers "
    
    
        class="nav-link"
    
    >Space Maintainers </a>

  
</li>
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</li>
<li class="nav-item dropdown cats nav-item-surgical-products 
 ">
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     title="Surgical"
    
        class=" dropdown-toggle lav1item" role="button" data-bs-toggle="dropdown" aria-expanded="false"
    
    
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  ">


    <a 


	href="https://dental.draft.webcart.us/infusion-set/" 


     role="button" role="button" title="Infusion Set"
    
    
        class="nav-link"
    
    >Infusion Set</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/surgical-blade/" 


     role="button" role="button" title="Surgical Blades"
    
    
        class="nav-link"
    
    >Surgical Blades</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/blade-removers/" 


     role="button" role="button" title="Blade Removers"
    
    
        class="nav-link"
    
    >Blade Removers</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


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	href="https://dental.draft.webcart.us/administration-sets/" 


     role="button" role="button" title="Administration Sets"
    
    
        class="nav-link"
    
    >Administration Sets</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


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	href="https://dental.draft.webcart.us/irrigation-solution-iv/" 


     role="button" role="button" title="IV Irrigation Solutions"
    
    
        class="nav-link"
    
    >IV Irrigation Solutions</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/packing-gauze/" 


     role="button" role="button" title="Packing Gauze Strips"
    
    
        class="nav-link"
    
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</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/absorbable-hemostatics/" 


     role="button" role="button" title="Absorbable Hemostatics"
    
    
        class="nav-link"
    
    >Absorbable Hemostatics</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/dry-socket/" 


     role="button" role="button" title="Dry Socket Paste"
    
    
        class="nav-link"
    
    >Dry Socket Paste</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/bone-graft/" 


     role="button" role="button" title="Bone Grafting Material "
    
    
        class="nav-link"
    
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</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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	href="https://dental.draft.webcart.us/membrane-plugs/" 


     role="button" role="button" title="Membrane & Plugs"
    
    
        class="nav-link"
    
    >Membrane & Plugs</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


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	href="https://dental.draft.webcart.us/tissue-adhesive/" 


     role="button" role="button" title="Tissue Adhesive"
    
    
        class="nav-link"
    
    >Tissue Adhesive</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/electrosurgery/" 


     role="button" role="button" title="Electrosurgery Units & Lasers"
    
    
        class="nav-link"
    
    >Electrosurgery Units & Lasers</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


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	href="https://dental.draft.webcart.us/nitrous-oxide/" 


     role="button" role="button" title="Nitrous Oxide"
    
    
        class="nav-link"
    
    >Nitrous Oxide</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/pappose-boards/" 


     role="button" role="button" title="Papoose Boards"
    
    
        class="nav-link"
    
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</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/blood-pressure-oximeters/" 


     role="button" role="button" title="Blood Pressure Units & Pulse Oximeters"
    
    
        class="nav-link"
    
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</li>


<li class="nav-item dropdown dropdown-submenu dropright  
  ">


    <a 


	href="https://dental.draft.webcart.us/bouffant-caps-shoe/" 


     role="button" role="button" title="Bouffant Caps & Shoe Covers"
    
    
        class="nav-link"
    
    >Bouffant Caps & Shoe Covers</a>

  
</li>


<li class="nav-item dropdown dropdown-submenu dropright  
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    <a 


	href="https://dental.draft.webcart.us/surgical-caps/" 


     role="button" role="button" title="Surgical Tie On Caps"
    
    
        class="nav-link"
    
    >Surgical Tie On Caps</a>

  
</li>
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</li>

        <li class="nav-item dropdown cats nav-item-dentu-lu 
                  
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          <a href="https://dental.draft.webcart.us/career/" title="Career" class="lav1item" aria-label="Career" role="link">Career</a>
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		  <li class="nav-item dropdown cats nav-item-medit-3d-scanner
                  
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			  <a href="https://dental.draft.webcart.us/medit-3d-scanner/" title="Career" class="lav1item" aria-label="Career" role="link">MEDIT 3D scanner</a>
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		  <li class="nav-item dropdown cats nav-item-deals ms-auto ">
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<li class="nav-item cats  offers1"><a href="https://dental.draft.webcart.us/botox-supply/" 
	                  title="BOTOX SUPPLIES" class="dropdown-item dropdown-item-botox-supply" >
	                   BOTOX SUPPLIES</a>
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		     <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="ASK_LNAME" class=" mandatory form-control" >
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		<div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">Company:</label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[COMPANY]" size="45" maxlength="255" dir="ltr" id="ASK_COMPANY" class=" form-control" >
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		 <div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">E-mail:<b class="madatorystar">*</b></label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="ASK_EMAIL" class=" mandatory form-control" >
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		     <input type="text" value="" name="DATA[PHONE]" size="45" maxlength="255" dir="ltr" id="ASK_PHONE" class=" form-control" >
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		    <textarea cols="30" rows="5" id="ASK_COMMENTS" name="DATA[COMMENTS]" dir="ltr" class=" form-control" ></textarea>
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<input type="hidden" name="BUFFER" value="CONTACT_US">
<input type="hidden" name="section" value="contact_form">
<input type="hidden" name="TAG" value="CONTACT5">
<input type="hidden" name="ac" value="insert">
<input type="hidden" name="next_action" value="default">
<input type="hidden" name="next_section" value="contact_us_thanks">
<input type="hidden" name="onerror_section" value="products">


	<input type="hidden" name="params[field]" value="MANUF">
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                        <!--Login form Starts-->
                        
                        <form action="https://dental.draft.webcart.us/index.php" method="post" name="login_form" id="main_login_form" class="">
                            <span class="hidden ajax_next_url"><!--replace this comment with URL--></span>
                            <DIV class="text-center form_err_message error_mess"><br>
                                <span class="form_email_error error_mess">Value entered for e-mail is invalid<br></span>
                                <span class="form_password_error error_mess">Passwords don't match<br></span>
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                            <div class="login_form">
                                <div class="form-group row email">
                                    <label class="col-3 col-form-label">E-mail:<b class="madatorystar">*</b></label>
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                                        <input type="text" value="" name="DATA[EMAIL]" size="35" maxlength="255" dir="ltr" id="LOGIN_EMAIL" placeholder="Enter your e-mail used as login" class=" mandatory email form-control form-control-sm" >
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                                        <input type="password" value="" name="DATA[PASSWORD1]" size="35" maxlength="255" dir="ltr" id="LOGIN_PASSWORD1" placeholder="Enter your account password" class=" mandatory form-control form-control-sm" >
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                            <input type=hidden name="ACC_TPY" value="CUSTOMERS">
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<div id="mm-quote" class="modal fade" tabindex="-1" aria-labelledby="mm-quoteLabel" aria-hidden="true">
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	<form action="index.php" method="post" name="contact_form" class="contact_form" data-json="1">

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							<label class="col-md-4 col-form-label text-md-end">Full Name: <b class="madatorystar">*</b></label>
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							  <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT10_LNAME" class=" form-control mandatory" >
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							<label class="col-md-4 col-form-label text-md-end">Company:</label>
							 <div class="col-md-8">
							  <input type="text" value="" name="DATA[COMPANY]" size="45" maxlength="255" dir="ltr" id="CONTACT10_COMPANY" class=" form-control mandatory" >
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						  <div class="row form-group mb-3">
							<label class="col-md-4 col-form-label text-md-end">E-mail: <b class="madatorystar">*</b></label>
							 <div class="col-md-8">
							  <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="CONTACT10_EMAIL" class=" form-control mandatory mail" >
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							<label class="col-md-4 col-form-label text-md-end">Comments or Questions:</label>
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							  <textarea cols="30" rows="5" id="CONTACT10_COMMENTS" name="DATA[COMMENTS]" dir="ltr" class=" form-control" ></textarea>
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       		 <input type="submit" name="submit" value=" Send " class="btn btn-primary">	

			
					<input type="hidden" name="BUFFER" value="CONTACT_US">
					<input type="hidden" name="section" value="contact_form">
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					<input type="hidden" name="next_section" value="catalog_request">
					<input type="hidden" name="onerror_section" value="products">
					   
					
						<input type="hidden" name="params[field]" value="MANUF">
	<input type="hidden" name="params[search_value]" value="bien-air-dental">
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<div class="modal fade" id="QUOTEModal" tabindex="-1" role="dialog" aria-labelledby="QUOTEModalLabel">
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      <div class="modal-body">


<form action="index.php" method="post" name="contact_form" class="form-horizontal contact_form" data-ga-event-category="contact_form" data-ga-event-action="submit" data-ga-event-label="CONTACT3">
<div align="center" class="error_mess ajax_errors" style="display:none"></div>
<DIV class="form_err_message error_mess" align="center">
	<span class="form_email_error">Value entered for e-mail is invalid<br></span>
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</DIV>


	<div class="form-group row">
	    <label class="col-sm-4 control-label">First Name<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[FNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT_FNAME" class=" mandatory form-control" >
	    </div>
  	</div>
  	<div class="form-group row">
	    <label class="col-sm-4 control-label">Last Name<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT_LNAME" class=" mandatory form-control" >
	    </div>
  	</div>
	<div class="form-group row">
	    <label class="col-sm-4 control-label">E-mail<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="CONTACT_EMAIL" class=" mandatory form-control" >
	    </div>
  	</div>
	<div class="form-group row">
	    <label class="col-sm-4 control-label">Phone</label>
	    <div class="col-sm-8">
	     <input type="text" value="" name="DATA[PHONE]" size="45" maxlength="255" dir="ltr" id="CONTACT_PHONE" class=" form-control" >
	    </div>
  	</div>
  	
	<div class="form-group row">
	    <label class="col-sm-4 control-label">Ship to Country<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	   	<select size="1" id="CONTACT_COUNTRY" name="DATA[COUNTRY]" dir="ltr" class=" mandatory form-control form-select" ><option value="USA" class=" " >UNITED STATES</option><option value="CA" class=" " >CANADA</option><option value="MX" class=" " >MEXICO</option></select>
	    </div>
  	</div>
  	<div class="form-group row">
	    <label class="col-sm-4 control-label">System you are interested in</label>
	    <div class="col-sm-8">
	   <textarea cols="30" rows="2" id="CONTACT_SYSTEM" name="DATA[SYSTEM]" dir="ltr" class=" form-control" ></textarea>
	    </div>
  	</div>
  	

	<div class="form-group row">
	    <label class="col-sm-4 control-label">Comments</label>
	    <div class="col-sm-8">
	   <textarea cols="30" rows="2" id="CONTACT_COMMENTS" name="DATA[COMMENTS]" dir="ltr" class=" form-control" ></textarea>
	    </div>
  	</div>


      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
        <input type="hidden" name="DATA[SKU]" value="">
		<input type="hidden" name="DATA[PRODUCT_NAME]" value="">
		<input type="hidden" name="DATA[LINK]" value="https://dental.draft.webcart.us/products/">
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