First NameLast NameMailing AddressEmail AddressCityDate of BirthStateZip CodePhone NumberOnly complete if patient was previously in another brandQualify for your 30 Professional Fees rebate with your ID: 856902
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1 How to eceive your ebate: 1. Get an ey
How to eceive your ebate: 1. Get an eye exam. 2. Puchase the equied 8 x 90 pack boxes between 04/01/2019 - 04/15/2020. 3. Mail in this completed oder fom with the followingess povided: a. Original eye exam eceipt with date cicled. b. Original sales eceipt showing poof of payment for your eligible contact lens puchase. Puchase must be made within 60 days of eye exam. Cicle contact lens puchase and date on eceipt. All eceipts must be fom the same eye cae practitioner who pescribed your contacts, or fom a location afiliated with that practitione. c. Email photo of each UPC code to rebate(See example of UPC code to the right.) @menicon.com along with your full name. First NameLast Name Mailing Address Email Address City Date of Birth State Zip Code Phone Number**Only complete if patient was previously in another brand. Qualify for your $30 Professional Fees rebate with your Eye Care Practitioner certification. I certify this patient has purchased the minimum Rebate submissions must be postmarked within 60 days of contact lens purchase. required quantity of eligible lenses.**This patient was upgraded from _______________ to Miru 1day Menicon Flat Pack.Practitioner Certification: _____________________________________________ REBATE TERMS AND CONDITIONS: Purchases of Miru 1day Menicon Flat Pack daily disposable contact lenses must be made 04/01/19 through 04/15/20 and rebate requests received at the mailing address on or before 06/15/20.Product purchase must be made within 60 days of eye exam. Limit one rebate per customer, per office, per 1day Miru purchase, per yearly exam visit. This offer is not valid in combinatio n with any other offer or rebate. Offer valid for U.S. residents only. Offer not valid where prohibited by law. Photocopy of the certificate is not valid for redemption. To qualify for both the $30 and $80 rebate, contact lens exam and contact lens purchase must happen at the same practice. Allow 6-8 weeks for delivery. Checks must be cashed within 60 days. No P.O. boxes, only street or rural addr esses are acceptable. Fraudulent submissions could result in federal prosecution under the U.S. Mail Fraud Statutes (18 U.S. Code Section 1341 and 1342). Not responsible for lost, late or undelivered responses. Rebate offers only valid through an eye care provider.*Annual supply rebate is an $80 product rebate and a $30 professional fees rebate. Menicon America, Inc. reserves the right to cancel this rebate program at any time without notice. Miru 1day Menicon Flat PackTo see, is to discove.To see, is to be moved.To see, is to laugh.To see, is to question.To see, is to understand.To see, is to shae. 7 Menicon America Mail-In Rebate Offer* MAIL TO:Menicon America, Inc.ATTN: Miru Rebate Program76 Treble Cove Road, Building 3North Billerica, MA 01862IMPORTANT:Make photocopies of your entire submission for your records. For questions regarding your rebate status, please call 800-636-4266 M-F 8:30am to 5:00pm EST. Allow up to 6-8 weeks for delivery.