Rebate Submission

Please fill out this form within 90 days of invoice. Allow 6-8 weeks for processing of rebate checks. Full terms and conditions can be viewed here.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Drop your files here
 

Rebate checks will be issued to the doctor (first/last name) provided. If it needs to be made out to the office or another name, please indicate here.