Rebate Form

Keystone Dealer Rebate Submission Form

Name of Business *

Street Address *

Zip/Postal Code *

City *

State/Province *

Phone

Business Owner Full Name *

Business Owner Email *

Rebate Offer *

Part Number (Part#) *

Invoice *

UPC Barcode(s) *

Submitted By

Email *

Q.1 Does your business have a physical retail showroom?
	Yes
	No

Q.2 Does your business support product installations?
	Yes
	No

Q.3 Would you like to subscribe to receive marketing emails, promotions, giveaways, and product news?
	Yes
	No