BROTHER QL-500 $20 REBATE OFFICIAL RULES & REGULATIONS 1. Complete this Rebate Claim form. A copy of this Rebate Claim Form is also available at www.brother.com. Please note that rebate claims must be received by mail at the address shown on this form and cannot be received by e-mail. 16. Brother reserves the right to request additional information regarding this claim and the right to confirm identification. All documentation submitted with this claim becomes the property of Brother and cannot be returned. 17. The claimant waives any and all claims against Brother relating to this offer. 18. Rebate checks are void 60 days after issue date. 2. Submit a copy of this sales receipt showing the product purchased and purchase date (dated between 11/1/04 and 4/16/05). NOTE: This rebate is not available for products purchased from Staples, Staples catalog and www.staples.com which manage their own rebate program. 3. Submit the proof-of-purchase by cutting out the original UPC bar code from the side of the carton. I have read and complied with all the terms and conditions listed on both sides of this Rebate Claim Form. 4. Rebate form and supporting documents (collectively ‘Claim’) must be postmarked no later than May 1, 2005 and be received by May 15, 2005. Please allow six to eight weeks to process. NAME __________________________________________________ 5. This form must be signed in order to be valid. COMPANY NAME ________________________________________ 6. Mail all of the above items to: Brother QL-500 REBATE DEPT 04-86518 P.O. BOX 028543 MIAMI, FL 33102-8543 If you have not received your rebate after 8 weeks, you may call 1-866-441-3015 or visit www.rebateshq.com to check the status of your rebate. Purchases must be made between November 1, 2004 and April 16, 2005. Purchases made before or after these dates will not be eligible. Any misrepresentations or fraudulent information disqualifies the claim. Offer is not valid in conjunction with any other Brother offer. Brother dealers, distributors, resellers and their employees and internal Brother orders are ineligible. Limit ONE rebate claim per model, per person, household, family or address. Only purchases by an end-user customer from an authorized Brother reseller in the 50 United States, the District of Columbia or Puerto Rico, that is a participating retailer, are valid. Offer void where prohibited, taxed or restricted by Federal, State, Provincial or local law. Any submission with invalid or undeliverable address will be rejected. Brother is not responsible for claims lost, stolen, damaged, illegible, misdirected or delayed in the mail. Please keep copies of all material submitted. No claims against “lost” materials will be evaluated unless accompanied by proof of receipt of the original claim by Brother (i.e., certified or registered mail). STREET ________________________________________________ 7. 8. 9. 10. 11. 12. 13. 14. 15. PLEASE PRINT CITY/STATE/ZIP _________________________________________ PHONE# (_____) ________________________________________ FAX# (_____) ____________________________________________ E-MAIL _________________________________________________ PRODUCT SERIAL # ______________________________________ (located on bottom of QL-500 machine) Offer # 04-86518 Rebate Offer good only on the Brother QL-500 model, listed below. Attach copy of receipt and original UPC Bar Code from carton (see sample below). Check amount claimed. MIR $20 MODEL# QL-500 UPC BAR CODE# 012502 610502 SAMPLE SIGNATURE ________________________________________