First Name: Last Name: Mailing Address: City: State: Zip: Cell Phone: Email Address: Preferred Item (Circle One) : Bose Ear Buds • Fitbit Flex • Coffee Maker • Kindle Fire Florida Seller of Travel Numbers: ST39966 Postmarked By: 10/22/16 TERMS & CONDITIONS • Rebate forms are completely transferable, but may not be resold under any circumstances. Notice of resell will void the rebate form. • Once your rebate form is received allow 7-14 business days* for processing and delivery. The product you selected will be sent to you via the US Postal Service. Failure to adhere to all Terms & Conditions may hinder the processing of your rebate form. *Expect delays during National holidays. • Offer not valid after postmarked date under any circumstance. • No duplicates of this rebate form will be accepted. • Failure to complete any line of this form will result in this rebate form being returned to you and will cause a delay in processing. • Offer good on any mattress or set purchase of Beautyrest Black from Raymour and Flanigan - 9/9/16 to 9/26/16. For questions related to the gift, please call 866-ELITE-21 or 866-354-8321 2 EASY WAYS TO REDEEM! 1. Mail this, along with a photocopy of your sales receipt that includes the bed name, size, purchase date and price purchased to Elite Rewards · PO Box 261147 · Tampa, FL 33685 with the provided self addressed postage paid envelope. 2. Scan your original receipt along with the completed form to [email protected] Signature By signing this form, you hereby agree to all Terms & Conditions