Rebate Submission

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.

Program Name*

Select or enter value

Go Big, Better and Beyond with Planmeca 3D

Select or enter value

Great Results Rebate

Select

First Steps to Big Dreams

Select

Live the Dream Rebate

Select or enter value

Live Event US

Select or enter value

Live Event Canada

Select or enter value

Event/Location*

Planmeca Sales Representative Name*

Doctor First Name*

Doctor Last Name*

NPI number

Practice Name*

Street Address*

City*

State/Province*

Select

Postal Code*

Doctor Email Address*

Office Phone Number*

Categories Purchased*

Select

Product Serial Numbers

Upload Dealer Invoice*

Drag and drop files here or

Notes

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.

Send me a copy of my responses

Privacy Notice|Report Abuse