Sample Request for

This form is open to US and CANADIAN Dentists who are interested in trying a sample of

a forerunner in self-adhesive resin cements that adheres to all materials including glass ceramics without the need for a separate silane or primer. The cement delivers a strong durable chemical bond to porcelain, zirconia, lithium disilicate and composite resin and offers easy cleanup.

Samples will be sent to qualified professionals in USA and CANADA only. Only one sample per qualified dental professional. Please expect a Kuraray Noritake Dental representative to follow up with you. Due to high demand please allow 4-6 weeks for your sample to arrive. By clicking submit, you agree to be contacted by Kuraray Noritake Dental. You also agree to receive emails with news and offers from Kuraray Noritake Dental, and agree to our Privacy Policy and Terms of Use.

Important Disclaimer

Kuraray America, Inc. Dental Division may offer rebates on certain sales promotions.

REBATES ARE NOT AVAILABLE TO DOCTORS AND PRACTICES THAT PARTICIPATE IN FEDERAL HEALTH CARE PROGRAMS. Participation in this rebate program and redemption of a rebate check(s) is not permitted if you or your practice is enrolled in, or bills any Federal health care program (e.g., Medicaid, Medicare, Tricare or Children’s Health Insurance Program) in whole or in part, for any good, facility, service or item, including, but not limited to, any dental, oral surgery or pharmaceutical goods or services. By redeeming a rebate check (s), you represent and agree that to your knowledge, neither you, or your practice nor other providers in your practice nor any of your patients are enrolled in or reimbursed by a Federal health care program for goods or services provided by you or your practice.