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A minimum of $25 for US orders and $250 for international orders is required.
Please make sure that your telephone number and e-mail address are both correct. We may need to contact you to confirm the information provided in this application.
A credit check is required to establish a Net 30 account.
Disclaimer:
Pearson Dental Supply is not responsible for problems resulting from the following: An incomplete application will result in delaying the opening of your account and pending orders from being processed. Additional information may be required. Incorrect address information will result in non-delivery of your orders and additional charges can be billed to your account.
International customers:
In addition to completing this application, please download the "Credit card and shipping authorization form" below, fill it and fax it back to us.
All fields with * are required.
Business address
*Business name
*Owner/Doctor's name
Purchasing agent
*Billing address
Suite/apt/unit (Specify whether suite, apt or unit)
*City
*State
*Zip code
*Country
*Phone
*Email
Please Note: We will not ship to P.O. Boxes and PMB (Private Mail Boxes), Hotels/Motels.
Please be sure to provide the correct shipping address. Any charges or loss incurred in the process of re-routing or making an address correction will be the responsibility of the customer.
Shipping address
*Contact name
*Shipping address
Suite/apt/unit (Specify whether suite, apt or unit)
*City
*State
*Zip code
*Shipping country
*Shipping Phone
Credit information
Social security number (Rquired for Net30 account)
*Tax ID number
*Driver's license number
*Driver's lic. state
Type of business
Important information
*State license number
Expiration date
*D.E.A. number
Expiration date
International customers:
Please fax a copy of your cedula, dental registration, dental certification, etc. to 800-498-4039.
Preferred method of payment
International customers:
Credit card and wire transfer are the only options. Please select one of the two.
If you are requesting a net-30 or C.O.D. account
Please type in capital "YES"
I authorize Pearson to request consumer reports from consumer reporting agencies to be used in considering this application. I have also read and agree to the terms & conditions at the bottom of this page.
Corporate accounts
Your account will not be established as a Corporate Account unless we receive your completed Corporate Application, Agreement and Guaranty.
C.O.D. orders
The limit for company check is $250.00. All orders over $250 must be paid with a cashier's check or money order. (No personal check). C.O.D. orders include a $13.50 charge, plus the shipping charge per shipment.
Credit card information
Credit card holder name (as shown on card)
Credit card number
Card verification number
Expiration date
Credit card type
Password for online access
Password
Select a password to access your Pearson login.
Do not use any special characters.
Note
For fraud protection purposes, Pearson Dental reserves the right to verify orders through a variety of means such as phone and license verification, request for copies of front and back of the credit card and a valid identification. Pearson Dental reserves the right to cancel any orders and void or credit any corresponding credit card transactions that it is unable to validate.
Terms & conditions
International orders terms & conditions
The following terms and conditions apply to the exportation of the shipment of your order:
A minimum order of $250 is required for all internet orders outside of the United States.
Pearson Dental is not liable for the shipment of your order once it is released to a transportation carrier.
Customer is responsible to be informed of the rules and regulations of the destined country for importing of dental/medical merchandise, and is also responsible for clearing the shipment with their own customs broker, pay all related fees (i.e. clearance, duties, taxes and all other fees relating to the clearance of shipment in their respective country). These charges are recipient's responsibility.
Shipping & Insurance fees
Shipments to other countries will be made through FEDEX, UPS or USPS (US Mail). Freight charges on international orders depend on carrier, as well as the weight and measurement of the packages. Your freight charge will be the exact amount charged by the carrier.
Additional Insurance
As some of the carriers do not insure the total value of the content of the packages shipped international, we automatically add third party insurance to cover the lost and damaged goods in the shipment.This additional insurance fee will be added to your freight charge.
Buyer will be responsible for shipping charges plus shipping insurance and/or any additional 3rd party insurance fees.
If your shipping address is outside of the United States, by clicking the submit form button, you agree to the International Orders Terms & Conditions above.
Terms and Conditions
By clicking the submit form button, you give Pearson Dental Supply Company permission to request consumer reports from consumer reporting agencies to be used in considering this Application and subsequently for the purpose of any update, renewal, extension of credit, reviewing or collecting on the account. Upon your written request, we will inform you of the name and address of each consumer reporting agency from which we obtain a consumer report relating to you. Proprietorships, Partnerships, or Corporations including professional corporations assume liability for ALL purchases made by any employee, manager, office, doctor, or pharmacist employed when the order was placed. I hereby agree to pay interest on all overdue accounts at the rate of 1.5% monthly, and to pay all costs of collection including reasonable attorney's fees. I hereby certify that the information set forth above, together with all other information submitted in connection with this application, is true and correct.
Please press the SUBMIT button only once.
This process may take a few seconds.
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