Dentist Order Form Please contact your dealer first. If you are unable to order from a dealer, please fill out the form. Company Name (required) First Name (required) Last Name (required) Phone Cell Phone Email (required) Street Address City State/Province Zip/Postal Products (please enter quantity in each box and we will contact you) 17" ET7V76ATM-2WhiteBeige 19" ET19ATM-2WhiteBeige 24" EX240ITS Accessories (please enter quantity in each box and we will contact you) 19V" Power Supply EX19V 12V" Power Supply FS60 8" DC Extension Cable ET08X 20" Extension Cable ET20DC 20" HDMI cable EX20HDMI Molex Cable ETC12M Base EXBase Remote for 24″ Monitor EXRE Remote for 17″ & 19″ Monitor ETR1 Δ