VSP & ACUVUE Brand Bonus Offer ® ® As a VSP® member receive higher rebates when you purchase ACUVUE® Brand Contact Lenses* 125 $ * $ When you purchase an annual supply of ACUVUE® Brand Contact Lenses In addition to your VSP ® & ACUVUE Brand rebate*, receive an ® 50 175 ** $ Rebate when you purchase a pair of featured brand sunglasses‡ TOTAL SAVINGS EXTRA $50 rebate toward your total purchase from your VSP® Doctor.** Get your rebate in 4 easy steps 1EYE EXAM AND PURCHASE You must have a recent eye exam and purchase the required number of ACUVUE® Brand Contact Lenses and a pair of featured brand sunglasses from a VSP® doctor within 90 days after the eye exam (eye exam receipt required). Limit one product rebate per customer, per offer, per ACUVUE® Brand purchase, per yearly eye exam visit. 2COMPLETE REBATE FORM Fully complete the rebate form on the back. 3 ATTACH RECEIPTS Attach eye exam receipt and product purchase (ACUVUE® Brand Contact Lenses and featured brand sunglass receipt(s). 4 MAIL TO 2014 ACUVUE® VSP® Marchon Rebate 386-208 P.O. Box 4019 Grand Rapids, MN 55730-4019 (Mail must be received by 4/30/14***) MONEY-BACK GUARANTEE We are so certain you will love your ACUVUE® Brand Contact Lenses that if for any reason you are not 100% satisfied, return them within 90 days and get your money back. Additional terms and conditions apply. See ACUVUE.com for details, or call 1.888.565.8474. Keep a copy of your paperwork for your records. See rebate terms and conditions below. (Please allow 8–10 weeks for delivery of your Visa® Prepaid card.) REBATE TERMS AND CONDITIONS: Rebate request must be received at the specified address and by the specified date on rebate form. Purchases of 1-DAY ACUVUE TruEye®, 1-DAY ACUVUE ® MOIST® and ACUVUE ® OASYS ® Brand Contact Lenses must be made 1/1/14 through 3/31/14 and rebate requests received at the mailing address on or before 4/30/14.*** Product purchase must be made within 90 days after eye exam. Limit one product rebate per customer, per offer, per ACUVUE ® Brand purchase, per yearly eye exam visit. This offer not valid in combination with any other product offer or rebate, including Money-Back Guarantee. Offer valid for U.S. residents only. Offer not valid where prohibited by law. Allow 8–10 weeks for delivery. Only original or printed form, as downloaded, is valid for redemption. No P.O. boxes, only street or rural-route 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. Only purchases made from a VSP ® network doctor are eligible for this higher rebate offer. NOTICE TO CONSUMERS: If you are personally filing a claim for reimbursement from a third-party payer (e.g., insurance company, employer group, etc.) for the purchase of this product, your claim must be based upon your payment less the amount of this rebate. If your doctor is filing the claim, you must notify the doctor’s office of the need to deduct this rebate amount from the purchase price used in calculating the claim. *VSP® Rebate is $25 more than the 2014 ACUVUE® Brand National Rebate; total rebate value reflected in amounts listed above. Rebate is in the form of a Visa Prepaid card, which expires one year after issuance. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi® Prepaid Services. Cards will not have cash access and can be used everywhere Visa® debit cards are accepted. Limit one combined VSP® rebate form per customer, per offer, per ACUVUE® Brand purchase, per yearly eye exam visit. Other terms and restrictions apply. **$50 Offer only available on featured brand sunglasses and select ACUVUE ® Brand Contact Lenses. Purchase(s) must be made with participating VSP ® Premier locations. VSP ® CIGNA® Vision and Medicaid members do not qualify for rebate offer. ***Johnson & Johnson Vision Care, Inc. or VSP ® reserves the right to cancel this rebate program at any time without notice. VSP® and ACUVUE® Brand Contact Lenses Rebate Form By submitting this required information, and any optional information below, you agree that it will be governed by the Privacy Policy outlined on www.ACUVUE.com. For whom are you completing this form?† †Required Field Myself О My Child О IF YOU SELECTED MYSELF Patient’s First Name† Patient’s Last Name† Date of Birth† Gender† Male ОFemale О Mailing Address† City† State† ZIP† IF YOU SELECTED MY CHILD Parent’s First Name† Parent’s Last Name† Date of Birth (parent)† Gender (parent)† Male ОFemale О Mailing Address† City† State† ZIP† Patient’s First Name (child)† Patient’s Last Name (child)† Doctor’s First Name† Doctor’s Last Name† Practice Name† Phone† City† State† Date of Purchase† My Coverage Is Through† ZIP† 1 †FILL IN CIRCLE TO INDICATE CONTACT LENSES PURCHASED AND WEARER TYPE. О Annual Supply of 1-DAY ACUVUE® MOIST® BRAND CONTACT LENSES (24 BOXES, 30 COUNT or 8 BOXES, 90 COUNT) NEW WEARER О Annual Supply of 1-DAY ACUVUE® MOIST® BRAND CONTACT LENSES for ASTIGMATISM (24 BOXES, 30 COUNT) О Annual Supply of 1-DAY ACUVUE® TruEye® BRAND CONTACT LENSES (8 BOXES, 90 COUNT) $125 REBATE О Annual Supply of ACUVUE® OASYS® BRAND CONTACT LENSES (8 BOXES, 6 COUNT or 2 BOXES, 24-PACK) О Annual Supply of ACUVUE® OASYS® BRAND CONTACT LENSES for ASTIGMATISM (8 BOXES, 6 COUNT) О Annual Supply of ACUVUE® OASYS® BRAND CONTACT LENSES for PRESBYOPIA (8 BOXES, 6 COUNT) 90-count size not available for 1-DAY ACUVUE® MOIST® for ASTIGMATISM NEW WEARER $75 REBATE 2 †FILL IN CIRCLE TO INDICATE FEATURED BRAND SUNGLASSES‡ PURCHASED. ‡$50 Rebate is limited to below list of sunglass brands О Airlock О Altair О Anne Klein О bebe О Calvin Klein О ck Calvin Klein О Chloé О Diane von Furstenberg О Dragon О Emilio Pucci О Flexon О G-Star О Genesis О JOE Joseph Abboud О Joseph Abboud О Karl Lagerfeld О Lacoste О MarchoNYC О Michael Kors О Nautica О Nike О Nine West О Revlon О Salvatore Ferragamo О Sean John О Sight for Students О Sunlites О Tommy Bahama О Valentino О X Games FEATURED‡ SUNGLASS $50 REBATE IMPORTANT NOTICE: If you redeem for the Money-Back Guarantee, you will not be eligible to receive a rebate. If you redeem for a rebate and then redeem for the Money-Back Guarantee, you will receive the full amount of the Money-Back Guarantee minus the rebate amount already issued to you. If your purchase is reimbursed by an insurance plan, you must notify the plan of your rebate or refund. See terms and conditions. ACUVUE ®, 1-DAY ACUVUE ® TruEye ®, ACUVUE ® OASYS ®, 1-DAY ACUVUE ® MOIST®, HYDRACLEAR® and SEE WHAT COULD BE ® are trademarks of Johnson & Johnson Vision Care, Inc. ©Johnson & Johnson Vision Care, Inc. 2013 The third-party trademarks used herein are trademarks of their respective owners. VSP ® and Vision Care for Life ® are registered trademarks. Marchon®, Flexon®, and MarchonNYC ® are registered trademarks of Marchon Eyewear, Inc. VSP ® Marchon Rebate Form CC13849 AS101317
© Copyright 2024 ExpyDoc
