UnderwoodPMB013125 - My Wine Rebate

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Name *

Address *

Address Line 1

City

State

Zip Code

Birth date *

Phone Number *

Valid E-Mail Address *

Date purchased? *

Select your qualifying rebate *

ORIGINAL RECEIPT ONLY. No altered receipts and must include name, address, and phone number of the retailer.

Upload a valid receipt. (maximum file size of 3MB) *

Retailer where purchased? *

Retailer Address *

Address Line 1

City

State

Zip Code

Terms and Rebate Conditions Agreement *

I understand and agree to rebate conditions, and further acknowledge using electronic communication (the internet) or the US Postal Service to receive a fraudulent rebate (my check) constitutes Rebate Fraud. Rebate Fraud is a Federal Crime and may result in Federal Prosecution, Mail Fraud Statute: 940. 18 U.S.C. SECTION 1341. Investigated by Federal Bureau of Investigation and or the Postal Inspection Service of the United States Postal Service. Those convicted of mail fraud can be fined up to $1 million and imprisoned for up to 30 years. Chapter 63—Mail Fraud and Other Fraud Offenses (link)

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