proudly made in the USA

Please send this form with your instrumentsAnd please ship safely so no harm is caused to those who handle. Thank you!

Practice Name:

Attention:

Address:

City, State, Zip:

Phone:

Email (required):

Distributor / Dealer:

Number and Brand of Instruments Sent (for every 12 instruments sent, choose 1 FREE below):

Ship to: American Eagle Instruments, Attn: Recycling, 6575 Butler Creek Rd, Missoula, MT 59808

Blackjack

Barnhart 5-6

M23

Eagleclaw

Gracey 13-14

H6-7

204S

FREE Instrument Choice(s):

Tear Here