Q3 2021 Promo Redemption Request

Q2 2022 Promo Redemption Request

Request your free goods by using the form below. Must submit this form with invoice by 7/31/22 to qualify. Offers valid only on purchases made between 4/1/22 and 6/30/22. If you have any difficulty with this form, please contact orders.usa@acteongroup.com.
Customer Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Customer/Office Email *
Office Name
Office Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Purchase or Upgrade Date *

Month Day Year
Select the Promotion you are Redeeming for free goods/rebate. *
List the "other" promotion you are redeeming.

Select the no charge Sopro Diagnostic camera (SoproLIFE or SoproCARE) that you are requesting. (Docking Station is included)
Select the no charge Sopix Sensor that you are requesting. MUST of equal or lesser value
If you have selected the PSPIX $1000 rebate, please complete the information below for the person that the check should be made payable.
First Name   Last Name
Email
Street Address   Address Line 2   City   State   Zip
If you are requesting the X-Mind Prime 3D CBCT free tuition for the upcoming Implant Pathway Compass AIS software training program in Mt Laurel NJ on July 23, 2022 plus a $750 credit for travel. Please complete the information below for the person that will be attending the course. This promotion is offered on a first requested, first granted basis. Promotion will be granted in the order request is received.
First Name   Last Name
Email
Street Address   Address Line 2   City   State   Zip
Area Code   Phone Number
If you are requesting one of the Newtron rebates, please complete the information below for the person that the check should be made payable.
First Name   Last Name
Email
Street Address   Address Line 2   City   State   Zip
Select the no charge NEWTRON Tip that you are requesting.
Select the no charge Piezotome II Tip that you are requesting.
Select the Bliss Offer you are redeeming.

Bliss Buy 5, Get 1 Bliss Buy 12, Get 3
Specify the no charge Bliss instrument you would like to receive. (Buy/Get promo only)
Specify the 2nd no charge Bliss instrument you would like to receive. (Buy/Get promo only)
Specify the third no charge Bliss instrument you would like to receive. (Buy/Get promo only)
Select the ADEK Newtron Integrated Promotional Tip Kit You Are Requesting.
Select the promotional box of Riskontrol that you are requesting.

Please add any additional comments about your order here
Dealer Invoice Number *
Please upload a copy of your invoice *

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Terms and Conditions:
- One offer per invoice
- Prior sales outside promotion period are not eligible
- All requests are subject to validation by ACTEON North America and may be denied or disqualified at ACTEON North America's sole discretion
- Allow 4 - 6 weeks for delivery of free goods
- Free goods eligible on qualifying purchases made between 4/1/22 and 6/30/22 and are based upon product availability
- Invoice must be received by 7/31/21
- By requesting free goods or rebate, you consent to receive occasional product announcements and special offers via email from ACTEON North America
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Q2 2022 Promo Redemption Request