Step 1: Enter the Promotion # for the rebate claim:
Promotion# Reseller Model# Period MIR Reseller Item # UPC code

  Step 2: Enter contact information: * required fields:
*First Name: *Last Name:
*E-mail Address:
*Address: USA Canada
*Street1 :
Street2 :
*City:   State:   Zip:
*City:   Province:   *Postal Code:
*Phone Number : ( ) -
*Purchase Date :
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