Midea Midwest Consumer Rebate Submittal Form

Midea Midwest Consumer Rebate Submittal Form
Name of Person Submitting Claim
Email address
example@example.com
Dealership Name
Dealership Address
Dealership City
Dealership State
Dealership Zip Code
Dealership Sales Rep Full Name
Homeowner Invoice Number
Date of Sale

MonthDayYear
Date
Date of Installation

MonthDayYear
Date
Total Sale before rebate
Rebate Amount
Outdoor Model Number
Serial Number
Model Number
Serial Number
Ductless Indoor Model Number
Serial Number
Model Number
Serial Number
Model Number
Serial Number
Model Number
Serial Number
Full Name (Homeowner)
Address (Homeowner)
City (Homeowner)
State (Homeowner)
Zip Code (Homeowner)
Homeowner Invoice (must display rebate deduction):
File Upload

Cancelof
Auer Steel Invoice:
File Upload

Cancelof
Signature
Claire
example@example.com
Verified Customer Number
Verified Rebate Amount
Issue Rebate
SubmissionID
Should be Empty: