Rebate/Submissions

All fields are required unless otherwise indicated.

Contact Information

First Name

Last Name

Address

PO Box not accepted

Address (line 2)

Optional

City

State

Zip Code

Email Address

Confirm Email

Phone Number

Purchase Information

Retailer Name

Retailer Name (Other)

(other - required)

Purchase Date

Product Purchased

Purchase Price

Please tell us why you were not satisfied with your purchase

Upload Receipt

Click here to choose a file, or drag it here

Accepted file types: JPG, PNG, PDF
Maximum file size: 20MB

Payment Method

Please choose how you would like to receive your Money Back Guarantee

I acknowledge that I have read and agree to the Terms and conditions of the program.