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Claim Form
End User Company Name*______________________________________________________________________________
End User Contact Name________________________________________________________________________________
End User Address_ ____________________________________________________________________________________
City_ _________________________________________________ State_ ________________ Zip_______________________
End User Phone_______________________________________________________________________________________
End User Email________________________________________________________________________________________
End User Signature__________________________________________________________________________________
I have read and agree to the terms and conditions of this rebate program.
Channel Partner Name_ ________________________________________________________________________________
Sales Person___________________________________________________Channel Phone_ _________________________
Channel Address______________________________________________________________________________________
City_ ____________________________ State _________ Zip _______________ Email_ ______________________________
If the End User cannot receive a check direct from Polycom, fill out this information:
Reason End User cannot receive a check directly from Polycom (See Terms and Conditions for details.
Reseller invoice must include a line item deduction off the total invoice amount for the full rebate amount)
q Please issue rebate check to reseller listed above (reason):
____________________________________________________________________________________________________
____________________________________________________________________________________________________
I have read and agree to the terms and conditions of this rebate program.
Signature___________________________________________________________________________________________
(Must be signed by an authorized End-User customer representative)
Polycom Products Purchased (the following information is required)
Number of SoundPoint IP Units Purchased:_ ________________
Number of SoundStation IP Units Purchased:________________
Number of Rebates Claimed: _____________________________ x $200 = Rebate Amount_________________________
(Please note, one rebate may be claimed for each combination of 5 SoundPoint IP phones and 1 SoundStation IP Phone
purchased. See program details for more information, and contact us with any questions.)
*The rebate check will be issued to the End-User customer unless the third box above is properly completed.
Proof of purchase
Provide photocopy of original white product label with product serial number from outside of each SoundPoint IP and
SoundStation IP box. Photocopies of proof of purchase are acceptable. Receipt or invoice must also be included.
Send completed trade-in documentation to:
Polycom Promotions, Promotion number: H29983, P.O. Box 100550, White Bear Lake, MN 55110-0550,
Fax 651-762-9701
(Email Subject line must contain: Polycom IP Bundle Program)
Polycom Headquarters
4750 Willow Road, Pleasanton, CA 94588
T 1.800.POLYCOM or +1.925.924.6000