Samsung Galaxy S 5$50 Cash Back Rebate Form

Samsung Galaxy S 5 $50 Cash Back Rebate Form
11/26 - 11/29/14
Your wireless phone purchase has qualified you for a $50 Cash Back via mail. In order to receive your check, you must send the
following documents in with this rebate:
• Copy of your Car Toys receipt
• Copy of your Carrier Activation Service Contract
(Note: You may black out any confidential information such as social security number and birth date.)
This Portion required to be filled out by Car Toys Staff:
Purchase Date (Month/Day/Year): _________________________________________________________________________________
Invoice Number: _______________________________________________________________________________________________
Wireless Phone Number (______) ___________-________________________
Authorization Code: TDAYGS550
Sales Person ID ________________________________
Rebate Qualifier :
• Phone must be purchase between 11/26/14 - 11/29/14.
• New activation or upgrade of with a 2-year agreement with AT&T or Verizon Wireless.
• Smartphone data plan required. Data must be active for 24 months.
• Limited to stock on hand. Verizon D-Fill orders excluded.
Total Qualifying Rebate Value: $50.00
Customer Portion (Please print clearly in black or blue ink.)
Name: ________________________________________ Your Daytime Telephone Number: (_______)________________________
Street Address:_____________________________________ City/State:___________________________ Zip:__________________
Email Address if you would like receive offers: ____________________________________________________________________
You must send a copy of your receipt, wireless contract & rebate form in order to receive your rebate check.
Trim along dotted line and keep with your receipts.
All rebate coupons must be post-marked within 30 days of the date of purchase.
Your check will be mailed to the address listed above 12 weeks after receipt.
The rebate form must be filled out in its entirety. Incomplete rebates will be returned to sender.
If you do not send a copy of the service agreement the rebate will not be honored.
All requests become the property of Car Toys and will not be returned. Use of multiple P.O. Boxes or addresses to obtain rebates will be
considered fraudulent, and will not be honored. Car Toys will not be responsible for any lost, late, damaged, misdirected, illegible, stolen
incomplete, postage due requests, or requests that fail to be delivered to the rebate address for any reason. Such requests will not be honored.
6. By participating in this rebate offer you release Car Toys and its respective officers, employees, and affiliated from any and all liability.
7. Limit one (1) coupon per phone activation on promotion. Some restrictions apply.
8. Please do not send via certified mail. Certified mail will not be accepted.
9. If phone is returned or deactivated, customer forfeits all rights to rebate payment.
10. To check status of your rebate/s please visit Status will be posted 30 days from submission date.
Mail this coupon to:
Wireless Rebate C/O Stuart Lee Rebate Center
P O Box 80001 Lynnwood, WA 98036-0015
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