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Subscription includes:

  • Automatic Badge Replacement for 1 year
  • Fully automated, computer generated report
  • Control badge provided at no additional cost
  • Reply envelope to send badges in for testing
  • myTLDaccount service for instant online access to your account

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    Dealer Account Number  
    Dealer/Account Representative E-Mail  
    Dealer P.O. Number  
    Clinic P.O. Number  
    *Clinic Name  
    Doctor  
    *Primary Contact  
    *Address  
    *City  
    *State  
    *Zip Code  
    *Clinic Phone Number  
    Clinic Fax Number : 
    *E-Mail  
    *Start My Contact On        
    *Frequency of Service : 
    *Type of Service : 
    *Yes, I want automatic annual renewal : 

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