Belmont Rewards Claim

Rewards Form

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This field is for validation purposes and should be left unchanged.

Unique ID

In order to process your form, we ask you to provide the following information. Please note that all fields and sections marked with an asterisk (*) are required.

Program(s)*

Eligibility

All eligible items must be ordered on a single dealer invoice to end users with a date between January 1, 2025 to December 31, 2025.
All claims must be submitted online by January 31, 2026.
Each qualified claim requires a completed spiff claim form and a valid invoice for verification. Pro forma invoices will not be accepted.
Each eligible claim will be paid in $100 increments in the form of an American Express gift card (rounded to the nearest hundred).
The program is exclusively available to active Equipment Sales Specialists.

Exclusions

The program does not apply to parts, freight, tax, bulk, and Special Markets pricing (limit one claim per invoice).
No additional types of awards, substitutions or requests for compensation will be accepted by Belmont Equipment as valid with this program.

**Please allow 4-6 weeks to review and process. Belmont Equipment reserves the right to terminate any and all programs without prior notice.

Claimant Information

Claimant's Legal Name (*)*

First Last

Claimant's E-mail**

Claimant's Phone Number*

Claimant's Address*

Street Address Address Line 2 City State ZIP Code

Belmont Representative*

Dealer Name*

Dealer Branch Location*

City State

Requested Shipping Address

Ship to the Claimant's Address

Product & Order Information

Upload Invoice*

Drop files here or

Max. file size: 8 MB.

Please upload the dealer-to-doctor invoice. All claims must include the invoice number and date.

Invoice*

Invoice #

Invoice Date

Comments