Free Goods Submission July 2015 Free Goods Submission Form Offer good on purchases made July 1-31, 2015. Cannot be combined with other specials or coupons. Submission for free goods must be received or uploaded by August 15, 2015. * Unit Purchased Select Unit Vantage Plus HFR Radiosurgery Which unit did you purchase for the July 2015 special? * Serial Number Serial Number located on the back or bottom of unit. * Email Address Email Confirm Email We do not sell, trade, or otherwise transfer to outside parties your personal information. Information collected is strictly for free goods submission. * Full Name First Last * Practice Name * Complete Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code Upload Proof of Purchase Max file size is 5 MB. Scan or take a picture of your warranty card or invoice. Once saved, click choose file (above), navigate and select the saved file to upload. Click submit. If you prefer to fax, click submit (below) and fax your warranty card or invoice to 302-645-0954.