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<CLIENT> CASHBACK

                    

Use this form to claim your <Client> cashback before <date>. This form needs to be:

1. submitted electronically AND
2. printed and posted, together with the product’s barcode and a copy of your receipt, to <address>

You will receive a Universal Gift Card that can be used at any store in the world that accepts VISA prepaid cards and can process them electronically.

You should expect to receive your card about one month after we receive all the necessary claim information from you.

If you have questions about the claim process, you can call us on <1300 number> 

 

The fields marked * are mandatory. 


Your name *

Address *

Suburb *

Postcode *

Best phone number *

This phone number will be used to create the authentication code for the Universal Gift Card.


Email address *


Date of purchase (ddmmyyyy) *

Item *

Model *

Serial no. *

Retailer *

Choose your reward

Date this form & barcode & receipt mailed to us (ddmmyyyy) *