RADcare Reseller Program Claim Form


Please enter the details of the RADcare services sold to be eligible to receive your 15% commission. All claims must be submitted no later than 90 days following customer purchase. Please fill in all fields and submit one claim form per sale.

Important: The RADcare Customer Registration form must also be completed, if not already done, in order to process your order. Click here to access the form.
     
*Date:
  
*Reseller/Integrator (company who sold to end-user):
  
*RAD MVP Channel Partner (supplier to reseller):
  
*RAD MVP Channel Partner contact name:
  
*End Customer Company Name:
 
*Serial Number of any Single item in order:
  
*List Price Value of RADcare contract sold:
 

Salesperson information		    
*Name (company or individual):
 
*Phone:
 
*Email:
 
*Street:
 
*City:
 
*State:
 
*Zip:
 
*Award Recipient's Social Security or Tax ID Number:
(SSN# or Tax ID is required for reporting purposes)
 
     
* Required field

  

Program Details
The program applies to new RADcare Level 1, Level 2 & Level 3 service agreement sales. RADcare service contracts must not be sold below published list prices. The RADcare Customer Registration form must be filled out and submitted prior to or along with the RADcare order. All claims must be received no later 90 days following customer purchase and are subject to verification by RAD. Claim forms will be processed by RAD within 15 days following receipt of payment for equipment and services. One claim per order. No other promotions can be combined with this offer. All taxes are the responsibility of the recipient.