$20

Rebate Request Form

CASH BACK

To say Thanks for joining our program were giving you $20 cash back towards the purchase of the product you ordered when you signed up. Just follow the easy steps below and well send you your rebate.
To receive your $20 rebate, complete this form and return it along with proof of purchase of the product you ordered when you first signed up for this program.
MAIL THIS FORM AND PROOF OF PURCHASE TO: Cash Back Rebate P.O. Box 5265 Hopkins, MN 55343-2265
All information below must be filled out completely to qualify for your rebate. Please print.

Subscription Number Purchase Total $ Name Address City State Zip

TERMS AND CONDITIONS: To redeem, complete this form and return it along with proof of purchase from the product you purchased when you initially signed up for this program to the address provided. Proof of purchase may be a copy of your order confirmation, copy of order summary, or a copy of your order receipt clearly stating the exact purchase amount (not including shipping & handling or applicable sales tax). This form may not be used in conjunction with any other offer, promotion, or coupon, and is non-transferable. Rebate is void if altered, counterfeited, or obtained or used improperly. Rebate has no cash value except when redeemed in accordance with these terms and conditions. Under no circumstances will rebate check exceed value of order. Illegible proofs of purchase do not qualify. Complete customer information must be included on rebate request form. Rebate will be sent in the form of a check. Please allow 8-10 weeks for processing.

Rebate Code 770