Cash Back Form
Click on the button below to download a cash back request form as a PDF document.

Click here to download the cash back request form.

Download Adobe Acrobat Click on the button above to download Adobe Reader.


Once you have printed the form,
  1. Go shopping.
    2.
  2. Fill out the cash back request form completely and select the products for which you are requesting cash back.
  3. Mail the form with original receipts (minimum of five eligible products with each request, all five items can be the same or different).
    4.

Your cash back check, as well as a new cash back request form, will arrive 4-6 weeks after submitting your request. If you would like to submit another cash back request form before your check arrives, simply download and print another form from this Web site or pick one up at an official retail outlet near you.

Remember, there is no limit to how many cash back request forms you can submit.