UOBG - United Orthodontic Buying Group

Complete the following signup form. It will then be submitted for review to see if you qualify to participate.

Prefix:

Username * :

Password * :

Confirm Password * :

Practice Name:

Email * :

Opt-in for communications from UOBG:

Yes, sign me up!

Address * :

Suite/Box:

City * :

State * :

Zip * :

Country * :

Dentsply Account Number:

My current Orthodontic supply company is:

If using GAC, what percent of GAC bands/brackets complete your appliance system?:

The name of the bracket/appliance system I currently use is:

Slot size:

I am now paying (per bracket):

I am now paying (per band/bracket combination):

I am:

a NEW GRAD

using a Grad Order Program

I was referred to/heard about UOBG from:

My office contact person is (name):

Please list other orthodontists currently in practice with you who wish to join UOBG.:

Terms and Conditions * :

Yes, I agree to the following terms and conditions: (1) I understand that UOBG members agree to purchase orthodontic supplies (brackets and bands) from the designated orthodontic supply company, DENTSPLY GAC. (2) New members will agree to convert to the UOBG designated orthodontic supply company within 90 days. (3) Continued membership is contingent upon adhering to 30 day net payment terms on all purchases. UOBG membership is by agreement, not contract and you may resign at any time.

Good to have some one on my side when dealing with these big orthodontic suppliers. No hassle. Just the best deal with UOBG.

Dr. Michael L. Stepovich

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