* Terms and Conditions. Offer effective from July 1, 2023 to December 31, 2023. Rebate request must be submitted no later than January 31, 2024. Valid in U.S. only. Rebate amounts shown are in U.S. dollars and all rebates will be paid in U.S. dollars. Completed rebate form with dealer invoice and photo triggers the rebate process. Rebates will be processed monthly and paid directly to the clinic or doctor named on the invoice. May be combined with Clinic Discount Policy, but may not be combined with any other equipment promotions.Orders that are canceled and rebooked will be rescheduled at current lead times. Returns: credit will be issued on unopened packages, minus 20% restocking fee and/or amount of qualified rebate. Promotional items are subject to product availability. A-dec reserves the right to change or cancel this offer at any time. This offer is void where prohibited, restricted, or taxed. Promo not available for National and Large DSOs. Promo is available for Emerging DSOs. 
 
 
 
 
 
 
 
 
Contact Information
 
 
 
 
 
First Name*
 
 
 
 
 
 
 
Last Name*
 
 
 
 
 
 
 
Clinic Name*
 
 
 
 
 
 
 
Email*
 
 
 
 
 
 
 
Phone*
 
 
 
 
 
 
 
 
 
 
Mailing Address
 
 
 
 
 
Street 1*
 
 
 
 
 
 
 
Street 2
 
 
 
 
 
 
 
City*
 
 
 
 
 
 
 
State/Province*
 
 
 
 
 
 
 
ZIP/Postal Code*
 
 
 
 
 
 
 
 
 
 
**Rebate Check will be payable to the clinic or doctor named on the dealer invoice**
 
 
 
 
 
Upload below dealer invoice of newly purchased A-dec compressor or vacuum PLUS photos of decommissioned/inoperative unit and SN tag
 
 
 
 
 
Upload dealer invoice and photos*
 
 
 
 
Upload dealer invoice and photos
 
 
 
 
Upload dealer invoice and photos
 
 
 
 
Upload dealer invoice and photos
 
 
 
 
 
 
 
*Required fields