Note: This letter of participation may be completed only by representatives of E&I member institutions. To determine whether your institution is a member, visit our . To join E&I, complete a Member Locator . Membership Application
My institution, (to include all ordering locations) listed below, wishes to participate in the E&I Contract with
Henry Schein - Dental Supplies. As of this date, please code all of my purchases to contract E&I CNR01271.
If you have any questions about this form or the E&I Master Agreement with
Henry Schein - Dental, please contact your or Member Relations Representative Mike Costigan by email at . firstname.lastname@example.org
By completing the form below, your Institution is requesting to be enrolled in the program.
* indicates a required field
We are a current Henry Schein - Dental customer. We are requesting to have all existing accounts (specified below) to be linked to E&I Master Agreement CNR01271. We are a new Henry Schein - Dental customer. We are requesting a new account to be set up and enrolled under E&I Master Agreement CNR01271.
Additional Contact(s) Please enter one contact per line. Please include the contact name, phone number, email address.
Account Number(s) Please enter one account per line. Please be sure to include account numbers if known.