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Tracking Number: 1014945734465720

Print and Sign Your Rebate Form

Mail Rebate To: (must match billing address on invoice or packing slip) Noah Mitchell 9319 E 81ST STAPT 231 TULSA, OK 74133 (918) 688-3488 onesavedboy@hotmail.com Offer Code: Item: PAT-10883 PCMPBO25 w/ US & TW POWER CORD Maximum: 2 per household Starts: Expires: Rebate Amount: $25.00 Must be postmarked within: Reseller: 08 / 01 / 2011 08 / 31 / 2011 30 Days of purchase Amazon.com

The American Express Reward Card : $25.00

I have read and agree to the terms of the rebate as described on the PatriotMem.4myrebate.com website. Signature: __________________________________________________ Date:________________ YOU MUST SIGN AND MAIL IN THIS FORM AND THE DOCUMENTATION REQUIRED TO RECEIVE YOUR REBATE

Mail In Rebate Form

Mailing Instructions:

1. Print this form Please print and mail this form to us. 2. Enclose all documents Attach all the required proof of purchase documentation to this rebate form and place everything in a mailing envelope. 3. Mail it Affix the label displayed below to your envelope. Envelopes without a proper label may not be delivered and processed.

4. This Submission Requires (please be sure to include all necessary documentation): Original UPC Barcode Label Completed Rebate Form Copy of Receipt or Invoice with the purchase circled

5. Confirmation A confirmation email that includes your tracking number for this rebate has been sent to the email address you provided. You will receive additional updates as your rebate status changes. Please allow 1 to 2 weeks after mailing your rebate application to receive an update to your status.

Please locate barcode label on your product (proof of purchase) similar to the one below and affix here. SAMPLE IMAGE, Not the actual size

IMPORTANT - Envelopes without a proper label may not be delivered and processed.

Rebate Processing Offer #: PAT-10883 P.O. Box 129331 San Diego, CA 92112-9331

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