Special Order Requests

Looking for more fresh ideas? We’ve got you covered! Browse additional custom options HERE. Simply select items, add to quote, and submit a quote request. Our team will contact you with special program options and pricing. *Display pricing on shop.halo.com may not reflect your special program pricing.

Have something else in mind? We can help! Merchandise options are not limited to what you see on the merch shop or shop.halo.com. Enter your merchandise request details on the SPECIAL REQUEST FORM (SRF) and our team will reach out to process your request. The SRF can also be used if you need a different variation of an item sold on the merch shop.

Please contact smiledoctors@halo.com with any questions.

Is this a request for Dental Kits?

Select or enter value

Please select from the following options:

Select or enter value

Is this a repeat of a previous order?*

Select

Your Name*

Phone Number*

How can we best reach you?

Your Email*

Previous Order Number*

Which item(s) are you looking to reorder?

Smile Doctors Brand or Affiliate?*

Smile Doctors

What is the Name of your Practice?*

Is this an item from the Merch Shop?*

Select

Please enter Merch Shop item numbers*

Items Requested*

Please use this space to tell us more about the kinds of items are you looking for. How will it be handed out? Who are the recipients? Do you require the use of a full color logo? Do you have a preference of product color? Anything else you’d like the HALO team to know about your vision for this project?

Quantity Needed*

Please note: the minimum order for Dental Kits is 200.

Budget or Estimated Price Point*

This will help determine product options that best fit your budget requirement.

Requested Delivery Date*

Note due to approval, production, and shipping times, we can get a time frame but cannot guarantee arrival dates. Please submit orders in advance.

Is this Delivery Date Firm?*

Select

What days does your address receive deliveries?*

Additional Details

Please note colors, logo placement, text or any other details you would like to include about your order request.

Upload Supporting Files

Examples, Logos or any other files you would like to include for your request may be loaded here.

Drag and drop files here or

Shipping Information for Your Request

Clinic Street Address*

No PO Boxes please

City*

State*

Select

Zip Code*

Office Location and Order Allocation

Select the Office Code, GL Code, Department and Allocation percentage for your order. You may enter up to four office locations and the allocation percentage must total 100%

Office Code #1*

Select

GL Code Office 1*

Select

Department for Office 1*

Select

Allocation Percentage (%) Office 1*

Office Code #2

Select

GL Code Office 2

Select

Department for Office 2

Select

Allocation Percentage (%) Office 2

Office Code #3

Select

GL Code Office 3

Select

Department for Office 3

Select

Allocation Percentage (%) Office 3

Office Code #4

Select

GL Code Office 4

Select

Department for Office 4

Select

Allocation Percentage (%) Office 4

Order Acknowledgement *

I acknowledge that I will receive an order confirmation via email and a proof. My order will deliver 3-4 weeks after proof approval.

Send me a copy of my responses

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