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Please send one free packet of 10 Clean-It® advanced denture wipes to the address listed below.

All fields are required unless noted.

First Name

Last Name

Your Address

Your City

Your State

Your Zip

Your Email

Your phone (*optional)

Gender:
MaleFemale

Age range:
18-3536-5555+

What do you currently use to clean your dentures?

Are you satisfied with the results?
YesNo

If not, please explain:

What do you currently use to remove denture adhesive from your dentures and gums?

Are you satisfied with the results?
YesNo

If not, please explain:

What other Denture products are you using?

Where do you shop for your Oral Care products?

Did you know there is a home-use denture reliner product available over-the-counter?
YesNo

Would you be interested in trying such a product?
YesNo

Have you tried our Reline-It® denture reliners?
YesNo

If so, were you satisfied?
YesNo

- If not, why?

Did you know there is a home-use denture repair product available over-the-counter?
YesNo

Would you be interested in trying such a product?
YesNo

Have you tried our Repair-It® denture repair kit?
YesNo

If so, were you satisfied?
YesNo

- If not, why?

Do you have any comments/questions about Clean-It® or any of our other products?

May we contact you after sending you the free sample of Clean-It to get your impression of the product?
YesNo

 
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Disclaimer:
Limit 1 free sample of each product per household or address.
Void where prohibited by law. Offer valid in USA only. Offer ends 12/31/2017.
Allow 4-6 weeks for delivery.