Shareshift Rebate Enrollment Form

Territory Manager

TM Email Address

Sales Director

SD Email Address

Account Number

Account Name

Account Phone Number

Annual Revenue Increase Opportunity

in dollars

P&L Report Upload

Comments/Reasoning

Base Rebate Structure

Rows	Annual Sales Volume Goal	Annual Sales Growth % Goal	Rebate Percent
Tier I
Tier II
Tier III

Bonus Rebate Structure

Boehringer Ingelheim (Equine Only)

Rebate Percent (biap)

Paid on (biap)

Select which categories to include. Each selection will require you to specify rebate percent and what the rebate is paid on. Letters in parentheses are for admin use only, and can be ignored.

Rebate Percent (biev)

Paid on (biev)

Rebate Percent (biep)

Paid on (biep)

Elanco

Rebate Percent (elap)

Paid on (elap)

Select which categories to include. Each selection will require you to specify rebate percent and what the rebate is paid on. Letters in parentheses are for admin use only, and can be ignored.

Rebate Percent (elip)

Paid on (elip)

Rebate Percent (elcr)

Paid on (elcr)

Rebate Percent (elca)

Paid on (elca)

Rebate Percent (elcp)

Paid on (elcp)

Rebate Percent (eltr)

Paid on (eltr)

Rebate Percent (elam)

Paid on (elam)

Rebate Percent (else)

Paid on (else)

Merck

Rebate Percent (mrap)

Paid on (mrap)

Select which categories to include. Each selection will require you to specify rebate percent and what the rebate is paid on. Letters in parentheses are for admin use only, and can be ignored.

Rebate Percent (mebr)

Paid on (mebr)

Rebate Percent (mese)

Paid on (mese)

Rebate Percent (mess)

Paid on (mess)

Rebate Percent (mecv)

Paid on (mecv)

Rebate Percent (metr)

Paid on (metr)

Rebate Percent (mecp)

Paid on (mecp)

Rebate Percent (meev)

Paid on (meev)

Rebate Percent (meep)

Paid on (meep)

Zoetis

Rebate Percent (zoap)

Paid on (zoap)

Select which categories to include. Each selection will require you to specify rebate percent and what the rebate is paid on. Letters in parentheses are for admin use only, and can be ignored.

Rebate Percent (zost)

Paid on (zost)

Rebate Percent (zosi)

Paid on (zosi)

Rebate Percent (zoph)

Paid on (zoph)

Rebate Percent (zop6)

Paid on (zop6)

Rebate Percent (zocv)

Paid on (zocv)

Rebate Percent (zocp)

Paid on (zocp)

Rebate Percent (zodi)

Paid on (zodi)

Rebate Percent (zoev)

Paid on (zoev)

Rebate Percent (zoep)

Paid on (zoep)

Rebate Percent (zodr)

Paid on (zodr)