Receive up to

$25Good for 1 prescription of 30 or more capsules of NalfonOffer valid until 12/31/11

*This rebate offer is brought to you by WraSer Pharmaceuticals.To receive a rebate on your out-of-pocket expenses, up to $25 for NALFON, com-plete the back section of this rebate form. Include your original pharmacy receipt showing your name, pharmacy name, and your purchase of NALFON, along with this form and mail to the address given on the back. NALFON (fenoprofen calcium) capsules are available only with a prescription. Offer is valid if prescribed before 12/31/11 and received by 12/31/11.

Mail-in Rebate* Offer

off your prescription ofNALFON 200mg and 400mg capsules(fenoprofen calcium capsules) 400 mg

(fenoprofen calcium capsules) 400 mg

Nalfon® is a registered trademark of Pedinol Pharmacal, Inc.

By fully completing this form, you will be eligible to receive a rebateequal to the amount of your out-of-pocket expenses, up to $25, on the retail purchase of your prescription for NALFON capsules*, subject to the terms and conditions below.

Please be sure to:

• Fill your prescription of NALFON.

• Clearly print your name and address and sign this rebate form.

• Enclose the original pharmacy receipt showing NALFON, your name and pharmacy name.

• Enclose the cash register receipt. Circle the amount paid.

• Mail to: NALFON Rebate Offer 121 Marketridge Rd. Ridgeland, MS 39157

Please Print Clearly:

Name __________________________ Date of Birth _____________

Address _________________________________________________

City _____________________ State __________ Zip _____________

Your Physician's Name:_____________________________________

Your Signature:___________________________________________*Offer expires 12/31/11. Please allow for 6 to 8 weeks for receipt of rebate. Offer good only in the USA. This offer is not valid for prescriptions eligible to be reimbursed, in whole or in part, by Medicare (including Medicare Part D), Medicaid, CHAMPUS, or the Department of Veterans Affairs, or any other similar federal or state pro-grams (including any state prescription drug assistance programs). Offer is not valid for prescriptions eligible to be reimbursed by any private indemnity or HMO plan or other health or pharmacy benefit program that reim-burses you for the entire cost of your prescription drugs. Offer is not valid for residents of Massachusetts whose prescriptions costs are paid all or in part by any insurer or other third-party payer, or where otherwise prohibited, taxed or restricted by law. This rebate is limited to $25 on NALFON® or your co-payment - whichever is less. You are responsible for reporting your receipt of this rebate to any private insurer that pays for or reimburses you for part or all of the prescription filled. No group or organization requests will be honored. Original pharmacy receipt must be included, and will not be returned. This form may not be reproduced and must accompany your request. Duplicate refund requests will not be accepted. WraSer Pharmaceuticals reserves the right to rescind, revoke, or amend this offer without notice.

I understand and agree to comply with the terms and conditions of this offer, as set forth above.

_______________________________________________________________________________________________(Patient’s signature required)

© 2011 WraSer Pharmaceuticals Wraser Website Offer

(fenoprofen calcium capsules) 400 mg