Submit Transactional Sales Accelerator Claim

First Name

Last Name

Address

Country

City

State/Providence

Zip Code

Phone Number

Dealer Name

Distributor

SSN

(SSN=XXX-XX-XXXX)

Electronic signature

Date

Serial Number

Model

Check this box if all Install information is the same for all serial numbers.

Sale Date

Eligible Amount

Dealer Sell Price

Sold Type

Please upload your evidence of sale