Redemption

INSTRUCTIONS

All fields with “*” must be completed and accurate for all valid claims
Product must be purchased according to the promotional period within US
Make sure to select your purchased item(s) and Free Good Item(s)
NOT ALL Free Good selectable models qualified for the Free Good Redemption you are requested for
Each Free Good Item selected equal to one (1) Free Good model and item
If you have more than one (1) Free Good to claim, please make sure you use the additional Free Good Item drop box to select (i.e. 2 Free Good Redemption need to fill-in 2 Free Good drop boxs)
Make sure to make accurate selection based on the original promotion rules associated to the correct promo code
Offer can’t be combined
All documents submitted must be dated within 30 days of original invoice (with doctor’s name or practice/facility) Date for all valid claims, unless otherwise stated
Please make sure to fill in all applicable purchased models and SNs in one form for all valid claims
Please expect Free Good(s) to arrive in 6 to 8 weeks after submitting all valid documents
Make sure to Register your purchased and promotional good(s) to keep all warranties valid
Please read the Warranty section for details on purchased and free good(s) return and refund policy
AG Neovo reserved the right to reject and terminate any claim and promotion without prior notice

Product Redemption Form

Profile

First Name *

Last Name *

Clinic Name *

Email *

Phone Number *

Street Address *

City *

State *

Zip code *

Dealer

Dealer's Name *

Original Invoice Number *

Promo Code *

Purchased Model

Purchased Model #*
Purchased Serial Number (SN) *Excluding symbol (ie -, / !)

Free Good Item

Free Good Item # *
Each Drop Box = 1 Free Good claim

Scan and attach original complete invoice *

Submitting format: PDF or JPG or PNG with maximum file size 1MB.

I have read and fully understood the contents. I agreed to all terms and conditions stated above. All confidential information is used solely for Product Redemption purpose and will not be shared nor sold to anyone.

[anr_nocaptcha g-recaptcha-response]