Submit your free goods reimbursement report and invoice below:

Dealer Name

Your First and Last Name

Email Address (to receive a copy of this submission)

Attach Detailed Report and Invoice (Click "Add another response" to upload multiple documents)

Click "Add another response" to upload additional documents.

 

Below are the required fields for all free good reimbursement reports (sample report below):

• Detailed Excel report that contains: 
• Customer Phone Number
• Customer Address
• Quantity purchased
• Quantity of free goods
• Total cost of free goods
• Invoice to Sterisil, Inc for the total cost of the free goods that matches the Excel report.

Sample Excel Report