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Additional Settings
I already have a Geistlich Account
Yes
No
Business Type
Sole Proprietorship
Partnership
Corporation
Government Department
Other
Business and Credit Information
Business Type
Sole Proprietorship
Partnership
Other
How many implants are placed at your practice per year?
less than 20
20 - 49
50 - 150
more than 150
1st Business/Trade Reference
Please note the following companies do not provide references, please list other trade references:
- Henry Schein
- Dentsply Sirona
- Ivoclar Vivadent
- Healthcare Essentials
- Oraltec
- Aluro
- Crown Medical
2nd Business/Trade Reference
Specialty
General Dentist
Periodontist
Prosthodontist
Endodontist
Maxillofacial Surgeon
Orthodontist
Orthopaedic surgeon
Other
Sales Terms & General Information
1. All invoices are to be paid in 30 days from the date of the invoice.
2. Claims arising from invoices must be made within seven working days.
3. By submitting this application, you authorise Geistlich Pharma New Zealand Ltd. to make inquiries into the banking and business/trade references that you have supplied.
Confirmation
I confirm that I am the authorised business owner or have been authorised by the business owner to sign this account application form.
Sales Terms & General Information
Be assured that our products do not prevent your patients from donating blood.
