| Air Techniques is committed to serving those in need. As part of our ongoing commitment we frequently grant requests for donations of dental equipment to local and international organizations seeking to provide or increase access to modern dental care. In order that we may efficiently handle all requests we must ask for the following information. Requests will only be accepted through our website and will be reviewed on a monthly basis. If it is decided to provide the requested equipment, we will contact the requesting party directly. |
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*Required Fields |
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| *Organization Name: |
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| *Contact Name: |
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| *Address 1: |
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| Address 2: |
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| *City: |
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| *State/Province: |
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| *Zip/Postal Code: |
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| *Country: |
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| *Phone: |
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| Fax: |
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| *Email: |
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| *Authorized Air Techniques dealer: |
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| *Services Provided: |
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| Years in Service: |
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| *Federal Tax ID#: |
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| *Dental equipment you would like to request: |
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*Date equipment is needed by: |
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