Case Shipment Checklist

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Magdalene Franklin
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1 Keep for your records. China Dental Outsourcing, Inc. Chengdu, Sichuan P.R. China US Telephone: (+1) US Fax: (+1) Case Shipment Checklist CDO UPS ACCOUNT # : CDO DHL ACCOUNT # OPEN A CDO ACCOUNT: To use our UPS and DHL shipping account numbers and receive discounted shipping rates, you need to open an account with China Dental Outsourcing, Inc. Please fax or call in your Credit Card Authorization (Visa Master Card, Amex, or Discover) using the form attached to this package. Or contact us for other payment options. You will receive your China Dental Outsourcing account number and shipping account numbers by . PREPARE SHIPMENT ANY BOX WILL DO, but use the SMALLEST box that adequately protects the cases. INSIDE THE BOX: Enclose your cases and the attached Prescription Lab Slip OUTSIDE THE BOX IN THE SHIPPING ENVELOPE provided by UPS/DHL: Insert three copies of the Commercial Invoice. Calculate Value for Customs at US$5/lb or US$10/kg (i.e.: box weighs 10 lb = US$50 Total Value for Customs ). IMPORTANT: Customs Value MUST be on shipment weight at US$5/lb (US$10/kg) Do NOT write cents. Write $20, not $ Prepare an International Air Waybill using UPS or DHL addressed to Xiao Fei Dental (see attached samples) Note: China Dental Outsourcing, Inc. & Xiao Fei Dental are two names for the same company. UPS and DHL require we use Xiao Fei Dental. ********************* Shipping Address *********************** Xiao Fei Dental Attention: Peter Cao CDO Chengdu, Sichuan CHINA Tel: CALCULATE the Declared Value for Customs based on shipment weight at US$5/lb (US$10/kg) and put on the International Air Waybill. ************************************************************ AFTER SHIPMENT: Forward a shipping tracking number to us immediately at admin@chinadentaloutsourcing.com. After we receive the shipment we will send you an invoice for the cost of the cases.

2 Fax or call in this information to open your account and receive out shipping account numbers China Dental Outsourcing, Inc. Chengdu, Sichuan P.R. China US Telephone: (+1) US Fax: (+1) Credit Card Authorization Fax Form Instructions: 1. Complete this form by printing legibly in dark ink all billing information in the blanks below. 2. Sign with the credit card holder s signature on the line indicated below. 3. Fax this form to our securely to USA: 1 (888) I, hereby authorize China Dental Outsourcing, Inc. to open an account and charge my credit card for dental laboratory services I request. Type of Card (circle one): Visa MC Amex Discover Credit Card Number: Expiration Date: CVC Code* *CVC Code is the last three digits of the number printed on the back of the Visa, MC and Discover credit cards. For American Express cards, the verification number is a 4-digit number printed on the front of your card. Credit Card Billing Information Company Name: Billing Name: Exact Billing Address: City: State/Province: Zip/Postal Code: Country: Telephone: FAX: for case questions: As the credit card holder, I hereby authorize receipt of merchandise at the shipping address above. Cardholder s Signature Date SHIPPING ADDRESS AND TELEPHONE Same as billing address. If not,then complete below. Company Name: Exact Shipping Address: City: State/Province: Zip/Postal Code: Country: Telephone: FAX: U.S.A. FAX: +1 (888)

3 One per case. US FDA Reg. No China Dental Outsourcing, Inc. Chengdu, Sichuan P.R. China US Telephone: (+1) US Fax: (+1) CASE INFORMATION Dentist / Laboratory: Your Case #: Patient Gender Age Date SERVICES (Circle Items) CROWN AND BRIDGE Porcelain Fused to Metal (PFM) 940 PFM Non-Noble 930A PFM High Noble (yellow) 930C PFM High Noble (white) 930B PFM Noble (white) 900 PFM Captek (yellow) 937 PFM Titanium alloy 942 Coping Non-Noble 933A Coping High Noble (yellow) 933C Coping High Noble (white) 933B Coping Noble (white) 931A Post/pin & PFM High Noble (yellow) 931C Post/pin & PFM High Noble (white) 931B Post/pin & PFM Noble (white) 941 Post/pin & PFM Non-Noble Full Cast 945 Crown/inlay/onlay full cast Non-Noble Crown Bridge Upper jaw Lower jaw 935A Crown/inlay/onlay full cast High-Noble, yellow 935B Crown/inlay/onlay full cast Noble, white 935C Crown/inlay/onlay full cast High Noble, white 920 King's Crown full cast (Au 97%, yellow) All Ceramic 971 IPS E.Max Crown 970 IPS E.Max Inlay/onlay 972 IPS E.Max Veneer 973 IPS E.Max 0.3 mm Veneer 978 Cercon Zirconia w/procelain 979 All Zirconia for Bruxers Other Bridge and Crown 943 PFM porcelain only 903 Implant Cercon Zirconia 960A Implant crown High Noble 960B Implant crown Noble 960 Implant crown Non-Noble 911A Maryland bridge High Noble 911B Maryland bridge Noble 912 Maryland bridge Non-Noble 936A Post/pin core High Noble 936B Post/pin core Noble 946 Post/pin core Non-Noble 959 Temporary crown 999 Veneer high strength acrylic REMOVABLE DENTURES - Partial Dentures 980 Partial metal framework w/o teeth (Cr Co) 981 Partial metal framework finish w/teeth 982 Partial metal framework setup with teeth 983 Partial metal framework setup w/o teeth 987 Acrylic Denture finish only 988A Valplast-Flexi partial denture, up to 4 teeth 988B Valplast-Flexi partial denture 5 or more teeth 988C Valplast finish only 989A Titanium framework incl. finish w/teeth 989B Titanium framework only 997 Attachment (incl. framework & teeth set up) 906 Clasp - Tooth color/transparent (each) 907 Gold-Plated Framework 998 Telescope (not including framework) Alloys Non-Noble Argen Argeloy N.P. Special, Cr 31.5%, Co 59.5% Noble White PFM & Cast Argen Argistar 43+ Pd 59.9%, Ag 28% High Noble Yellow PFM Argen Argendent 74, Au 74%, Pt 4% High Noble Yellow Cast Argen Argenco 56, Au 55.8%, Pd 4.1% High Noble White PFM & Cast Argen Argedent Euro, Au 40% CERAMIC SHADE Cracklines Transparency Translucency Shade: Use Vita/Bioform Shade Guide CONTACTS Normal Heavy & Broad Point OTHER SERVICES 932 Porcelain margin 994A Bite registration 994B Wax Rim 991 Night guide 992 Bleaching guide 995 Snoring guide 993 Custom tray or Individual tray 901 Diagnostic Wax up per jaw (over 4 units) 902 Diagnostic Wax up per unit 908 Composite Veneer (Hi-impact acrylic) 996 Electroplating coping 100% Au 950 Non-Noble composite build up teeth 913 Fixed Space Maintainer 914 Removable Space Maintainer 915 Orthodontic applicator Full Acrylic Dentures 986A Full acrylic denture including teeth 986B Full acrylic denture incl. teeth (Hi-impact) 985 Acrylic denture finish 984 Acrylic denture setup 909 Acrylic denture Repair 100 Soft lining 101 ID Denture Return Date: Dr. License Number: Dr. Signature: CDO Basket/Item: TOOTH NUMBERS / CASE DESIGN Lingual Metal Porcelain Margin Standard (Modified Ridge) Point Contact MARGIN DESIGN If Insufficient Occlusal Clearance... Metal Occlusal Reduction Coping No Metal Small Metal PONTIC DESIGN No Contact No Ridge Below Ridge (Bullet) SPECIAL INSTRUCTIONS See back for additional instructions and/or sketches

4 Insert 3 copies in plastic shipping envelope on the outside of the box. Your company is the manufacturer. Do NOT put cents on the values, i.e., write $20, not $ Company: Attention: Address: FROM: COMMERCIAL SHIPPING INVOICE TO: Company: XIAO FEI DENTAL Attention: Peter Cao CDO Address: High-Tech District, Tianfu Life Science Park 88 Ke Yuan Nan Road Bldg B1-202 Chengdu, Sichuan Country: Country: CHINA Postal Code: Postal Code: Telephone: Telephone: (+86) FAX: U.S. FAX: (+1) Your Order Number (if any): Full Description of Goods : Dental Impressions Samples Manufacturer: No. of Items: Item Value: Total Value for Customs: Reason for Export: Samples Signature: Date : H.S. Code: CR Code (Calculate at US$5/lb or US$10/kg)

UPS International Express Waybill 4WV517 Peter Cao 86 28

5 UPS International Express Waybill 4WV517 Peter Cao Xiao Fei Dental S 2nd Rd Chengdu, Sichuan X (Calculate at US$5/lb or US$10/kg) If no Express Saver on your form, select EXPRESS and write SAVER to the right of 1

6 DHL International Express Waybill X DENTAL IMPRESSION SAMPLES CR Code Xiao Fei Dental H.S. Code: Peter Cao (Calculate at US$5/lb or US$10/kg) High-Tech District Tianfu Life Science Park Chengdu, Sichuan CHINA x x

Quick Start Guide. Effective January PFm - $125. Emax - $170 EMA - $150. Toll Free. Full Contour Zirconia - $140 Layered Zirconia - $205

Quick Start Guide. Effective January PFm - $125. Emax - $170 EMA - $150. Toll Free. Full Contour Zirconia - $140 Layered Zirconia - $205 Effective January 2015 Quick Start Guide PFm - $125 Full Contour Zirconia - $140 Layered Zirconia - $205 EMA - $150 Emax - $170 Night Guard - $130 Cast Metal Partial- $315 * Premium Denture - $290 Duraflex