Spiff Authorization Form

Manufacturer Name*

Contact*

Title*

Phone*

Email*

Proposed Start Date*

Proposed End Date*

Spiff Description*

Specific Products Included*

(List or attach below all eligible product numbers.)

Eligible Product Numbers File*

Max. file size: 100 MB.

Eligible Burkhart Associates*

Account Managers
Equipment Specialists
Service Technicians
Clinical Digital/Technology Specialists
Regional Sales Managers
Other

Please Specify

Payout Method*

Check
Credit on Account
Gift Cards (must be provided and distributed by manufacturer)
Award Trip
Reward Points

Reporting Needs*

Baseline Report
Final Report and Invoice
Progress Reports (additional fee applies)

Desired Start Date

Desired End Date

Frequency

(Not more than monthly.)

Manufacturer Contact Agreeement*

I agree to the Terms & Conditions below.

1. All spiff or sales contest programs of any kind must be approved in advance by Burkhart via this form.
2. All Spiff Programs are subject to a $500 Administration Fee plus $100 for each Progress Report, if applicable, separate from awards.
3. Payouts are due within 30 days of Program end. Burkhart reserves the right to short pay invoices in the event of late payments.
4. Manufacturer agrees to provide a pdf announcement, approved by Burkhart, which adequately defines the program, payout amounts and timing, eligible products, and eligible Burkhart Associates prior to launch of the program.
5. Program announcements/updates shall be made only through Burkhart communication channels, unless otherwise agreed.
6. Check and Credit on Account payments must be made to Burkhart for payroll disbursement to qualifying Associates.
7. Burkhart is unable to track leads, conversions, new user qualifications, etc. Manufacturer shall be responsible for capturing this information through other reporting or their field sales team.
8. If a customer rebate is tied to a spiff, Manufacturer is responsible for processing and disbursing rebates to end-user customers.

Phone

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

Manufacturer Spiff Authorization Form