Miru 1day Menicon Flat Pack To see, is to discover. 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 share. How to receive your rebate: 1. Get an eye exam. 2. Purchase the required 8 x 90 pack boxes between 04/01/2015 - 09/30/2015. 3. Mail in this completed order form with the following materials to the address provided: a. Original eye exam receipt with date circled. b. Original sales receipt showing proof of payment for your eligible contact lens purchase. Purchase must be made within 60 days of eye exam. Circle contact lens purchase and date on receipt. All receipts must be from the same eye care practitioner who prescribed your contacts, or from a location affiliated with that practitioner. c. Email photo of each UPC code to [email protected] along with your full name. First Name Date of Birth Last Name Mailing Address City State Zip Code Phone Number Gender Email Address MAIL TO: Menicon America, Inc. ATTN: Miru Rebate Program 281 Winter Street, Suite 180 Waltham, MA 02451 IMPORTANT: 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. Qualify for your $30 Professional Fees rebate with your Eye Care Practitioner certification. Have your practitioner complete the statement below. I certify this patient is new to contact lenses or was upgraded from ___________________ to Miru 1day Menicon Flat Pack and purchased the minimum required quantity of eligible lenses. Practitioner Certification: _____________________________________________ REBATE TERMS AND CONDITIONS: Purchases of Miru 1day Menicon Flat Pack daily disposable contact lenses must be made 04/01/15 through 09/30/15 and rebate requests received at the mailing address on or before 10/16/15. Product purchase must be made within 60 days of eye exam. Limit one rebate per customer, per office, per 1day Miru purchase, per early exam visit. This offer is not valid in combination 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 addresses 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. *$80 Product rebate and $30 Professional Fees rebate **Menicon America, Inc. reserves the right to cancel this rebate program at any time without notice.