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Customer Information: (address where check should be mailed)
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Purchase Information:
*Purchase Date: (MM/DD/YYYY) *Name of Dealer: *Dealer City: *Dealer State:
Sales Invoice Number:
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What combination of products did you purchase?
Viking Built-in Refrigeration   Viking Built-in Refrigeration and Cooking

Products purchased:
Viking Built-in Refrigerator:
*Model Number: *Serial Number: *Total Rebate Earned:
Model Number: Serial Number:
Model Number: Serial Number: