Axeos + DI Purchase Includes CEREC Software

Axeos + DI Purchase Includes CEREC SW

Axeos and Primescan AC bundle includes CEREC SW
Customer Information
Customer Name*

First NameLast Name
Practice Name*
Customer Email*
example@example.com
Customer Phone Number*

Area CodePhone Number
Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Order Date*

MonthDayYear
Date
Distribution Partner*
Distribution Customer Number*
Primescan Serial Number*
CEREC SW Product SKU Number*
Invoice/ Order Number*
Invoiced price indicating other promotional offers applied to the Extraoral Imaging or CADCAM equipment exceeding in value by more than 5% from the Manufacturer’s Advertised Price are not qualified to redeem the offers indicated on this form.
Proof of Purchase- Invoice*

Browse Files
Please attach a copy of your invoice and signed agreement for CEREC SW if applicable. Cancelof
Invoice Bundle Amount*
Axeos and Primescan total purchase amount
Email to Send PDF of Form:
example@example.com
To the extent required by law, customers must (i) fully and accurately disclose the amount of this discount in any cost report or claim for reimbursement submitted to Medicare, Medicaid or other federal healthcare program; and (ii) comply with any request to provide documentation of the discount to representatives of the Secretary of Department of Health and Human Services and State agencies. Please allow 1-2 weeks for delivery of Software after form submission.
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Axeos + DI Purchase Includes CEREC SW