3 STEPS TO SUBMIT YOUR EXAM REBATE
**minimum box purchase requirement doctor signature required for eye exam rebate
1. GET an eye exam and PURCHASE qualifying contact lenses 1/01/201706/30/2017
2. VISIT BauschRebates.com and enter this offer code: 17-90202
3. SUBMIT all information requested and upload your supporting documents listed below:
Original sales receipt showing proof of payment for your eligible contact lens purchase(s). Purchase must be made within 60 days of eye exam. Circle contact lens purchase and date on receipt.
Original UPC symbols from EACH qualifying box.
Original eye exam receipt with date circled.
Your right to receive this rebate will not be earned unless you satisfy each of the conditions of acceptance described on this form. Your failure to follow each of these steps is a rejection of this rebate offer. Resolution of any disputes will be governed by New York law. The Mail-in Rebate Offer is valid on purchase of the following Bausch + Lomb contact lenses: Bausch + Lomb ULTRA, Bausch + Lomb ULTRA for Presbyopia, Biotrue ONEday, Biotrue ONEday for Astigmatism, Biotrue ONEday for Presbyopia, SofLens daily disposable and SofLens daily disposable For Astigmatism. Purchase of the qualifying product(s) is required to qualify for this rebate offer; no product substitutions, deletions, or additions are allowed, regardless of information learned from other sources. This offer is available to all customers with mailing addresses in the U.S. and Puerto Rico. Purchases made in or for delivery to other countries are not eligible. Bausch + Lomb is not responsible for lost, late, damaged, illegible, misdirected or postage-due submissions. Your rights to this offer cannot be assigned or transferred and this offer is void where taxed, restricted or prohibited by law. All submitted materials become Bausch + Lomb property and will not be returned. One rebate per person, per 12 month period. Limit five (5) rebates per address per 12 month period except where prohibited. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD) applies, but is waived for the first six months after the card is issued. Your card is issued by MetaBank, Member FDIC, pursuant to a license from Visa U.S.A. Inc. Cards can be used at any merchants that accept Visa debit cards within the United States. Bausch + Lomb reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Excessive submissions constitute fraud and may result in federal prosecution under the U.S. mail fraud statutes (Title 18, USC 1341 and 1342). NOTICE TO CONSUMERS: If you are personally filing a claim for reimbursement from a third-party payor (e.g., insurance company, employer group, etc.) for the purchase of this product, your claim must be based upon your payment less the amount of this rebate. If your doctor is filing this claim, you must notify the doctors office of the need to deduct this rebate amount from the purchase price used in calculating the claim. Purchases made at Costco or from internet retailers are not eligible. Please contact Costco or internet retailers for their specific offers. Valid only on purchases from a VSP doctor.
Biotrue, MoistureSeal, SofLens, Bausch + Lomb ULTRA and inspired by the biology of your eyes are trademarks of Bausch & Lomb Incorporated or its affiliates. All other product/brand names or logos are trademarks of the respective owners. 2016 Bausch & Lomb Incorporated. PNS08040 17-90202 BOD.0325.USA.16
IMPORTANT: Make photocopies of your entire submission for your records. To review the status of your submission at anytime, visit www.bausch.com/rebates. If you do not have Internet access, call (855) 806-3231 M-F 8am to 7pm CT. Allow up to 60 days for processing and delivery.
To qualify for the exam rebate, this section must be completed by your eye care practitioner Practitioner Certificate: Date: _____/_____/________
I certify the patient applying for this offer was fitted for contact lenses.
Doctors signature is required in order to be eligible for the exam rebate. Contact lens exam rebate eligibility requires minimum box purchase and contact lens exam from same location as minimum box purchase.
Were proud to partner with Optometry Giving Sight. You can join us, and help provide sight to millions by donating some or all of your rebate. If youd like to participate, simply select your
donation amount during the online submission process and well take care of the rest.
Submission must be postmarked within 60 days of your contact lens purchase. All receipts must be from the same eye care practitioner who prescribed your contacts, or from a location affiliated with that practitioner.
Example of UPC
QUALIFYING PRODUCTS ANNUAL SUPPLY Plus EXAM FEE REBATE
Bausch + Lomb ULTRA family of contact lenses
$60 off 4 boxes**
Biotrue ONEday contact lenses
$90 off 8 boxes** of 90 pks + $30 off exam fee
Biotrue ONEday for Presbyopia and Biotrue ONEday Astigmatismcontact lenses
$120 off 8 boxes** of 90 pks or 24 - 30 pks
SofLens daily disposable contact lenses
$70 off 8 boxes** of 90 pks + $30 off exam fee
SofLens daily disposable contact lenses For Astigmatism
$70 off 24 boxes** of 30 pks + $30 off exam fee