Professional Account

New Customer Web Notice – What to Expect!

To ensure that your request is met in a timely manner and to prevent order delays:

A Shiny Whitening Team Member will contact you to validate your account request.
New customers and customers who have not yet established approved open Credit Terms with Shiny Whitening must provide a credit card with all orders.

Important Note: Order processing will be delayed until account validation and valid payment are established. Additionally, please have your license and pertinent information available when a Shiny Whitening Team Member contacts you if you are ordering pharmaceuticals.

Disclaimer

Please review the following before submitting your request.

Shiny Whitening sells dental and medical products to licensed professionals, dental students, and other licensed businesses. We do not sell dental & medical products to the general public. Orders placed online by non-licensed personnel or entities will be cancelled without notification.

Please continue only if you are a licensed dental or medical provider, dental student, or licensed business in need of health care products.

Account Type

Tell us what type of business you are so we can set up your account correctly.

Account Type

Tell us what type of business you are so we can set up your account correctly.

Account Type*

Tax ID / VAT Number*

License Number

DEA / Registration Number

Business Information

Basic information about your practice or organization.

Practice / Business Name*

Website

Main Phone*

Fax

Primary Contact

Who should we contact regarding this account?

First Name*

Last Name*

Email*

Direct Phone

Shipping Address

Where should we send your orders?

Address Line 1*

Address Line 2

City*

State / Province*

ZIP / Postal Code*

Country*

Agreement

Please review and confirm your information before submitting.

I confirm that the information provided is accurate and I agree to the Terms & Conditions. *

Once your request is submitted, our team will review your details and contact you with your account number and next steps.