BOVIGEN Platinum Protection Program Reimbursement

BOVIGEN Platinum Protection Program Reimbursement

We’re sorry you are unsatisfied with you BOVIGEN™ Platinum Vaccines. Please complete the information below so we can begin the reimbursement process. Customers must provide proof of purchase of the Eligible Vaccines to receive the Refund.

If you need to report an adverse event please contact Virbac’s Product Safety and Product Consulting Team at 1-800-338-3659.

Reimbursement

Name:
Address (Line1):
Address (Line 2):
City:
State:
Postal Code:
Phone:
Email
Farm/Clinic Name:
Veterinarian's Name:
Veterinarian's Phone Number:
Date:

Products you purchased:

: BOVIGEN™ Platinum 5 Vaccine BOVIGEN™ Platinum 5 L5 Vaccine BOVIGEN™ Platinum 3 Vaccine BOVIGEN™ Platinum 3 LP Vaccine
Reason for dissatisfaction (500 words max):
Date of Product Purchase:
Place of Product Purchase:
Amount of Reimbursement requested:
Upload invoice (#1):
Upload invoice (#2):
Upload invoice (#3):

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