1 User Information 2 Payment Information BEGIN YOUR LUMIWHITE TEETH WHITENING JOURNEY BY COMPLETING THE FORM BELOW. £630 (Dental Practice Price) £399 (LUMIWHITE Online price) £359.99 or £14.99 per month (online price after using code: LUMI2023) WHAT'S INCLUDED: ✓ B1 Tooth Shade we don't just guarantee whiter teeth ✓ Full Dental Assessment with a LUMIWHITE dentist (worth £150) ✓ Teeth Whitening Kit day & night options available (worth £400) ✓ Superseal Whitening Trays made just for you ✓ Mirrored Case to store your whitening trays ✓ FREE Gift x1 top-up whitening syringe (worth £80) 1. Customer Details Full Name * Address Line 1 * City/Town * Postcode * Email Address * Phone Number * Referred By 2. Teeth Whitening Preference (copy) We have a range of DAY and NIGHT whitening options to choose from and they all whiten teeth effectively! Choose your preferred teeth whitening kit from the options below * LUMIWHITE BY DAY - whiten for 1½ hours per day LUMIWHITE BY DAY - whiten for 2 hours per day (for sensitive teeth) LUMIWHITE BY NIGHT - whiten overnight LUMIWHITE BY NIGHT - whiten overnight (for sensitive teeth) Choose the location of your LUMIWHITE Teeth Whitening dentist (we will strive to match you with a LUMIWHITE Dentist in your preferred location and within a 20 miles radius of the postcode you have provided us with) * Choose preferred locationAmershamAshton-under-LyneAylesburyBarnetBarnsleyBasildonBath and North East SomersetBatleyBeaconsfieldBedfordBelfastBirminghamBlackburnBlackpoolBorough GreenBournemouthBradfordBrentfordBrighton and HoveBristolBuckinghamshireCambridgeshireCanterburyCardiffChalfont St. GilesCheshireChesterChiswickCornwallCreweCumbriaDarlingtonDealDerbyDevonDewsburyDoncasterDorsetDublinDurhamEast YorkshireEccleshallEdinburghEssexGlasgowGloucestershireGlynneathGreater ManchesterHampshireHartlepoolHertfordshireHigh WycombeHuddersfieldKentLancashireLeedsLeicesterLeicestershireLewishamLincolnshireLondonMacclesfieldManchesterMarket HarboroughMarlowMelton MowbrayMerseysideMiddlesboroughMilton KeynesNeathNorthamptonshireNorthumberlandNorwichNottinghamNottinghamshireOldhamOrpingtonOxfordshirePeterboroughPeterleePlymouthPontypoolPoolePortsmouthPrestonReadingSevenoaksSheffieldSomersetSouthamptonSouthportSouth YorkshireStaffordStalybridgeStoke-on-TrentStoneSunbury-on-ThamesSuffolkSunderlandSurreySwanleySwanseaTamesideWarwickshireWest YorkshireWhitstableWiltshireWolverhamptonOther Add LUMI SOOTHE Desensitising Gel to your purchase (2.5ml syringes x2) - £39.99 £60.00 Add LUMI SOOTHE Desensitising Gel to your purchase (2.5ml syringes x2) - £39.99 £60.00 LUMI SOOTHE is a revolutionary, fast-acting, desensitising gel that can be used before and/or after teeth whitening. It contains two active ingredients, Potassium Nitrate and Sodium Fluoride, which are clinically proven to minimise tooth sensitivity and promote tooth remineralisation. 3. Payment Options Payment Status Amount PAY IN FULL (£399)PAY WITH INTEREST-FREE FINANCE (£99 upfront then 6 monthly payments of £50) Discounted Amount Discount Code Apply Discount Apply Discount Select your payment method PAY NOW (Debit/Credit Card) PAY NOW (PayPal) PAY LATER (6 Interest-Free Payments) PAY LATER (24 Interest-Free Payments) Agree to Terms * I have read and agree to the Terms of Service AFTER PLACING YOUR ORDER, A LUMIWHITE REPRESENTATIVE WILL CONTACT YOU WITHIN 48 HOURS TO ARRANGE YOUR FIRST APPOINTMENT WITH YOUR LOCAL LUMIWHITE DENTIST. Validate Email