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Claim form

 IBM System x Express Microsoft License Cashback Offer Request Form ZA09-1048.
 IBM System x Express Server Memory Cashback Offer Request Form ZA09-1050
 IBM System x Express Server Hard Drive Cashback offer Request Form ZA09-1049

Please check box for applicable promotion.

To qualify for the rebate this signed form, along with all requested documentation, must be received no later than 30 days after the invoice date, at :

IBM Express Claims
PO Box 3560
Maidenhead
SL6 9YE
United Kingdom
Email : info@express-claims.com

IBM will confirm receipt of your rebate request by email. Qualifying IBM System x and options purchased:

Note: Please ensure that each server purchased is itemised on a separate line and that all serial numbers are provided.
Incomplete detail may result in a rejected claim and/or a delay in rebate payments. Please complete all that apply.

Machine Type Model and Serial Numbers :
MS License Part Number claimed :
(if applicable)
Quantity and Invoice date :
HDD Part Number claimed :
(if applicable) Part Number, Quantity and Invoice date :
Memory Part Number claimed :
(if applicable) Part Number, Quantity and Invoice date :
Total rebate amount claimed:
Name of Business Partner :
Address :
Contact information
End User Company Name
(print clearly) :
Contact Name :
Address :
Mailing address (if different) :
City :
County :
Country :
Postcode :
Email Address :
Daytime Phone :
I certify by my signature that I am in compliance with the terms and conditions of this rebate offer, and that all of the information I have entered on this Rebate Request Form is accurate, complete, and in accordance with the rebate request instructions.
Signature :
Date :
Name (Please print) :
Title & Company Name :
 

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