Haier 43E4500R Serenity Rebate US_MAIL - Page 2

Go to www.HaierPromotions.com to enter your claim online Online submissions are processed faster. Only complete the mail-in form below if you are not submitting online. Instructions for mailing your claim: NOTE: Only for eligible purchases made between June 1-July 31, 2015 1. Complete ALL information on this form including serial numbers for the products. Incomplete forms will not be paid. 2. Include purchase invoice or sales slip (circle the model numbers and date of purchase) and this rebate form. 3. Mail no later than August 31, 2015 to: Haier Rebate ­- HAIERAC062015REBATE PO Box 2100 Wayne, NJ 07474-2100 To check rebate status, go to www.HaierPromotions.com NOTE: You must provide a valid email address to track status update. Questions: Please call 1-855-875-9143 First Name: Last Name: PO Boxes Not Accepted Address 1: Address 2: City: State: Zip: Please submit no later than August 31, 2015 Email*: Store Name: Promo Code: HAIERAC062015REBATE *We only use email to provide claim status updates. We do not compile, share or sell email address lists. Phone: Serial Number: Check Appropriate Box: In Store Purchase Online Purchase Check here if you do not want to be contacted by Haier Date: Customer Signature: Eligible Air Conditioner and Dehumidifier Models Model DE45EK Rebate $25 Model ESA408N Rebate $25 Model ESA418K Rebate $40 DE45EM $25 ESA4102 $25 ESA418M $40 DE65EK $25 ESA410K $25 ESA418N $40 DE65EM $25 ESA410M $25 ESA424K $40 ESA4062 $25 ESA410N $25 ESA424N $40 ESA406K $25 ESA4122 $25 ESAQ406P $25 ESA406M $25 ESA412K $25 ESAQ408P $25 ESA406N $25 ESA412M $25 EST08XCM $25 ESA406P $25 ESA412N $25 EST08XCP $25 ESA4082 $25 ESA415K $40 EST10VCM $25 ESA408K $25 ESA415M $40 EST10VCP $25 ESA408M $25 ESA415N $40 EST10XCM $25 HWH12A $25 HWH12B $25 HWH18A $40 Model EST10XCP EST12VCM EST12XCM EST12XCP HM50EP HM70EP HPB08XCM HPD10XCM HPN10XCM HPN10XHM HPN12XCM HPN12XHM HWH18B Rebate $25 $25 $25 $25 $25 $25 $25 $25 $25 $25 $25 $25 $40 Model DE45M HPF12XCM HPF12XHM HPN14XCM HPN14XHM HPND14XCP HPND14XHP HPRB08XCM HPY08XCM HPY12XCN HPYD12XCN HPYD12XHN HPYD14XCN HPYD14XHN HTWR08XCK HWH24A Rebate $25 $25 $25 $40 $40 $40 $40 $25 $25 $25 $25 $25 $40 $40 $25 $40 ← Serial Number ← Model Number Model HPF14XCM HPFD12XHP HPYD13XCN HTWR10VCK HTWR10XCK HTWR12VCK HTWR12XCK HWE06XCN HWE08XCN HWE10XCN HWE12XCN HWE15XCN HWE18VCN HWE24VCN HWH08A EST12VCP Rebate $40 $25 $40 $25 $25 $25 $25 $25 $25 $25 $25 $40 $40 $40 $25 $25 Disclosure: Card is issued by The Bancorp Bank, Member FDIC, pursuant to a license from Visa U.S.A. Inc. Your card is pre-loaded with value and may be used in the United States and U.S. Territories wherever Visa debit cardsare accepted. The card may not be used at any merchant, including internet and mail or telephone order merchants, outside of the United States or U.S. Territories. Please include this page when completing a Mail-In Rebate. Don't forget to include a copy of your store invoice. Page 2 of 2