good example of a rebate form

http://ak.buy.com/buy_assets/retail/pdfs/08Q1/0201-0229dw-rg_50d-link.pdf

Name: __
Product/Description UPC Code Rebate
Offer valid February 1, 2008 through February 29, 2008. See below for details.
Address: __
E-mail Address: (Optional) __
City/State/Province: ___Zip/Postal Code: ___
This Mail-In Rebate is valid on purchases of the above listed products at Amazon.com, Buy.com, eCost.com, Newegg.com,
Provantage.com and Zipzoomfly.com between 02/01/08 and 02/29/08.
To qualify for this rebate, please make sure you complete ALL of the following steps:
1) Completely fill out this rebate form (PLEASE PRINT)
2) Include a copy of your dated sales receipt from the qualifying purchase.
3) Include the ORIGINAL UPC CODE cut from the box of the qualifying products. See below for Sample.
4) Mail ALL of the above required documents to:
D-Link Offer # DLC-11609
Etail Feb 2008 MIR’s
PO Box 650001
El Paso, TX 88565-0001
For questions regarding the status of your rebate, please visit http://www.web-rebates.com/dlink, or call (800)279-4763. Please allow 4 weeks before
checking the status of your rebate.
REBATE REQUESTS MUST BE POSTMARKED
WITHIN 30 DAYS OF THE DATE OF PURCHASE
• Rebate forms sent directly to D-Link will not be honored
• Allow 8-10 weeks for processing
• Valid in USA only (including Alaska and Hawaii)
• One rebate per person/per product/per address
• Not valid with any other offer
• Promotion valid while quantities last
• Refurbished or Recertified products do not qualify
Mail-in Rebate Form
D-Link Offer #DLC-11609
We suggest you make a copy of all materials for your records.
Void where taxed, prohibited, or restricted by law. D-Link is not responsible for late or misdirected mail. Fraudulent submission of multiple requests could result in
federal prosecution under the U.S. Mail Fraud Statutes (18 USC. Sections 1341 and 1342). D-Link, MediaLounge and D-Link logo are trademarks or registered
trademarks of D-Link Corporation or its subsidiaries in the United States and other countries. Copyright © 2008 D-Link Corporation, Inc. All rights reserved.
You must include the ORIGINAL UPC
CODE cut from the box. The UPC
Code can be found on the back of the
box in the bottom left corner.
Would you like to receive future communications via email from D-Link? Yes□ No□
DSM-320RD - Wireless Media Player 790069 270413 $50
DPH-50U - Skype USB Phone Adapter 790069 289743 $10