Free Goods & Rebates

To process your rebate and/or your free product, please complete and submit the form below. Dealer invoice must be submitted along with this rebate form for processing.

Free Goods & Rebates Form

Select the option that best identifies you in the redemption process

User Type

Dental Practice

General Info

Practice Name:

Practice Phone:

Ext.

Practice Contact:

First Name:

Last Name:

Email:

Title

Practice Address

Shipping Address 1:

Address 2:

Shipping City:

Shipping State

Shipping Zip:

Order and Redemption Info

Dealer

Invoice #

Which quarter was the order placed in?

Select the offers you are looking to redeem for the invoice listed above.

Q4-2024 Solmetex Offers

#1 - Buy 3 NXT Hg5 Collection Container, Get 1 case PowerScrub Free#2 - Buy 2 NXT Hg5 Collection Container, Get PowerScrub Intro Kit Free#3 - $450 Rebate on NXT DryVac#4 - PowerScrub Vacuum Line Cleaner - Buy 1, Get 1 PowerScrub Intro Kit Free

Make Rebate Checks Payable to

Q4-2024 Sterisil Offers

#5 - Sterisil Straw - 3+1 Value Pack: Buy 1, Get 1 box FASTCheck15 free#6 - Buy 3 FastCheck15 boxes, Get 1 free#7 - Buy 1 Citrisil 4-Pack, Get 1 box FASTCheck15 free#8 - Buy 1 Sterisil R2A Waterline Test, Get 1 box FASTCheck15 free#9 - Buy 2 boxes Citrisil Shock, Get 1 box FASTCheck15 free#10 - Buy 3 Inline or Valved Cartridges, Get 1 Free#11 - $300 Rebate on Sterisil AC+ System#12 - $400 Rebate on Sterisil G4 or G5 System

Make Rebate Checks Payable to

Q4-2024 DryShield Offers

#13 - Buy 2 DryShield Isolation Systems, Get 1 System FREE#14 - Buy 2 DS Lites, Get 1 DS Lite FREE#15 - Buy 2 Boxes Autoclavable Mouthpieces, Get 1 Bottle PowerSonic Free#16 - Buy 5 Boxes AUTOCLAVABLE Mouthpieces and receive 1 DryShield® Isolation System (DS-SYS-001) at no charge.#17 - Buy 4 Boxes (AUTOCLAVABLE) Mouthpieces, Get 1 free#18 - Buy 4 Boxes (SINGLE-USE) Mouthpieces and receive 1 free

Q3-2024 Solmetex Offers

#1 - Buy 3 NXT Hg5 Collection Containers, Get 1 Case PowerScrub Vacuum Line Cleaner#2 - Buy 2 NXT Hg5 Collection Containers, Get 1 PowerScrub Intro Kit Free#3 Get a $450 rebate with the purchase of an NXT DryVac#4 - PowerScrub Cleaning Solution - Buy 1, Get 1 Intro Kit

Make Rebate Checks Payable to

Q3-2024 Sterisil Offers

#5 - Sterisil Straw 4 Pack - Buy 1, Get 1 Box FASTCheck15 Free#6 - FASTCheck15 - Buy 3, Get 1 Free#7 - Buy 1 Citrisil Maintenance Tablets 4-Pack, Get 1 Box FASTCheck15 Free#8 - Buy 1 Sterisil R2A Waterline Test, Get 1 Box FASTCheck15 Free#9 - Buy 2 Citrisil Shock, Get 1 Box FASTCheck15 Free#10 - Sterisil Cartridges 3+1#11 - Sterisil AC+ Rebate ($300)#12 - Sterisil System G4 & G5 Rebate ($400)

Make Rebate Checks Payable to

Q3-2024 DryShield Offers

#13 - Buy 2 DryShield Isolation Systems, Get 1 System FREE#14 - Buy 2 DS Lites, Get 1 DS Lite FREE#15 - Buy 2 Boxes AUTOCLAVABLE Mouthpieces and get 1 bottle PowerSonic Free#16 - Buy 5 Boxes DryShield AUTOCLAVABLE Mouthpieces, Get 1 Isolation System Free#17 - Buy 4 boxes DryShield Autoclavable Mouthpieces, Get 1 box free#18 - Buy 4 Boxes DryShield Single-Use Mouthpieces, Get 1 Box Free

Expected DryShield Free Goods

DryShield Products

Other Product

Quantity

Upload the relevant invoice

Dealer Field Rep

Rep Information:

First Name:

Last Name:

Email:

Phone:

Dealer

Order and Redemption Info

Invoice #

Which quarter was the order placed in?

Select the offers you are looking to redeem for the invoice listed above.

Make Rebate Checks Payable to

Q4-2024 Solmetex Offers

Make Rebate Checks Payable to

Q4-2024 Sterisil Offers

Make Rebate Checks Payable to

Q2-2024 DryShield Offers

Q3-2024 Solmetex Offers

#4 - PowerScrub Cleaning Solution - Buy 1, Get 1 Intro Kit

Make Rebate Checks Payable to

Q3-2024 Sterisil Offers

#5 - Sterisil Straw 4 Pack - Buy 1, Get 1 Box FASTCheck15 Free#6 - FASTCheck15 - Buy 3, Get 1 Free

#7 - Buy 1 Citrisil Maintenance Tablets 4-Pack, Get 1 Box FASTCheck15 Free

#8 - Buy 1 Sterisil R2A Waterline Test, Get 1 Box FASTCheck15 Free#9 - Buy 2 Citrisil Shock, Get 1 Box FASTCheck15 Free

#10 - Sterisil Cartridges 3+1

#11 - Sterisil AC+ Rebate ($300)

#12 - Sterisil System G4 & G5 Rebate ($400)

Make Rebate Checks Payable to

Q3-2024 DryShield Offers

#13 - Buy 2 DryShield Isolation Systems, Get 1 System FREE

#14 - Buy 2 DS Lites, Get 1 DS Lite FREE#15 - Buy 2 Boxes AUTOCLAVABLE Mouthpieces and get 1 bottle PowerSonic Free#16 - Buy 5 Boxes DryShield AUTOCLAVABLE Mouthpieces, Get 1 Isolation System Free#17 - Buy 4 boxes DryShield Autoclavable Mouthpieces, Get 1 box free#18 - Buy 4 Boxes DryShield Single-Use Mouthpieces, Get 1 Box Free

Expected DryShield Free Goods

DryShield Products

Other Product

Quantity

Upload the relevant invoice

Practice Info

Practice Name:

Practice Phone:

Ext.

Practice Contact:

First Name:

Last Name:

Email:

Title

Practice Address

Shipping Address 1:

Address 2:

Shipping City:

Shipping State

Shipping Zip:

This customer is confirmed as being eligible to receive the discounts, free goods, and/or rebates based on the distributor policy.

Yes, confirmed

Solmetex

Solmetex Water Specialist

Water Specialist Information:

First Name:

Last Name:

Order and Redemption Info

Dealer

Invoice #

Which quarter was the order placed in?

Select the offers you are looking to redeem for the invoice listed above.

Q4-2024 Solmetex Offers

Make Rebate Checks Payable to

Q4-2024 Sterisil Offers

#5 - Sterisil Straw - 3+1 Value Pack: Buy 1, Get 1 box FASTCheck15 free#6 - Buy 3 FastCheck15 boxes, Get 1 free#7 - Buy 1 Citrisil 4-Pack, Get 1 box FASTCheck15 free#8 - Buy 1 Sterisil R2A Waterline Test, Get 1 box FASTCheck15 free#10 - Buy 3 Inline or Valved Cartridges, Get 1 Free#11 - $300 Rebate on Sterisil AC+ System#12 - $400 Rebate on Sterisil G4 or G5 System

Make Rebate Checks Payable to

Q4-2024 DryShield Offers

#13 - Buy 2 DryShield Isolation Systems, Get 1 System FREE#14 - Buy 2 DS Lites, Get 1 DS Lite FREE#15 - Buy 2 Boxes Autoclavable Mouthpieces, Get 1 Bottle PowerSonic Free#17 - Buy 4 Boxes (AUTOCLAVABLE) Mouthpieces, Get 1 free#18 - Buy 4 Boxes (SINGLE-USE) Mouthpieces and receive 1 free

Q3-2024 Solmetex Offers

Make Rebate Checks Payable to

Q3-2024 Sterisil Offers

#10 - Sterisil Cartridges 3+1

#11 - Sterisil AC+ Rebate ($300)#12 - Sterisil System G4 & G5 Rebate ($400)

Make Rebate Checks Payable to

Q3-2024 DryShield Offers

Expected DryShield Free Goods

DryShield Products

Other Product

Quantity

Upload the relevant invoice

Practice Info

Practice Name:

Practice Phone:

Ext.

Practice Contact:

First Name:

Last Name:

Email:

Title

Practice Address

Shipping Address 1:

Address 2:

Shipping City:

Shipping State

Shipping Zip:

For your free box of Single-Use DryShield mouthpieces: what size do you want? (Only applies to related Promotions)

PedoSmallMediumLarge

For your free box of Autoclavable DryShield mouthpieces: what size do you want? (Only applies to related Promotions)

X-PedoPedoSmallMediumLarge

Black Friday 2024 (Expires Dec 7)

Sterisil Offers

Buy 1 Straw Value 4-Pack Get 2 Boxes of FASTCheck15 Free

Solmetex Offers

Buy Any Solmetex or Sterisil Product, Get 1 DryShield Isolation System FreeBuy 1 Case of PowerScrub, Get 1 Case FreeBuy 1 case of PowerSonic, Get 1 Case Free

DryShield Offers

Buy 2 boxes of DryShield Single-Use Mouthpieces, Get 1 DryShield System FreeBuy 1 Starter Kit, Get 2 DS Lites FreeBuy 1 DS Lite, Get 1 FreeBuy 1 Single-Use Mouthpiece, Get 1 FreeBuy 4 Autoclavable Mouthpieces, Get 1 Autoclavable Mouthpiece Free

Contact Information

Limited time offer, specials only valid on purchases dated between October 1, 2024 – December 31, 2024. Rebate forms must be received by February 15, 2025. Offers not valid with any other promotions. Offers may be discontinued or changed without notice and void where not valid. Offers for Solmetex and Sterisil products only apply to customers and distribution partners within the USA. Offers for DryShield products apply only to customers and distribution partners in the USA and Canada.

All ‘Q3 2023 Specials’ rebate forms must be received by November 11, 2024.

Free Goods & Rebates