Acuvue mail in rebate form

Here is a sample Acuvue Mail-in Rebate form:

Acuvue Rebate Form

Rebate Offer: Get a $5 rebate on the purchase of Acuvue contact lenses.

Eligibility:

• Must be a resident of the United States or Puerto Rico
• Must be 18 years or older
• Must purchase Acuvue contact lenses from a participating retailer
• Must submit a completed rebate form with a copy of the receipt and proof of purchase

Rebate Amount: $5

How to Redeem:

1. Complete the rebate form below
2. Attach a copy of your receipt and proof of purchase
3. Mail the completed form and attachments to the address listed below

Rebate Form:

Name: __ Address: __ City: __ State: __ Zip: __ Email: __ Phone: __

Purchase Information:

• Date of Purchase: _____
• Retailer Name: ___
• Product Name: Acuvue Contact Lenses
• Quantity: __
• Price: $____

Receipt and Proof of Purchase:

• Please attach a copy of your receipt and proof of purchase to this rebate form.

Mail-in Rebate:

• Mail the completed rebate form and attachments to:
  • Acuvue Rebate
  • P.O. Box 540
  • Princeton, NJ 08542-0540

Deadline: Rebate submissions must be postmarked by [insert date].

Limitations:

• One rebate per household
• Rebate offer valid for purchases made between [insert dates]
• Rebate offer not valid in combination with other offers or discounts
• Acuvue reserves the right to modify or cancel this rebate offer at any time

By submitting this rebate form, I certify that I am the original purchaser of the Acuvue contact lenses and that I have not previously submitted a rebate claim for these products.

Signature: __

Date: __

Please note that this is just a sample form and the actual rebate form may vary depending on the retailer and the specific rebate offer. Be sure to check the official rebate form for any specific requirements or restrictions.