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Preferred Item (Circle One): Bose Ear Buds • Fitbit Flex • Coffee Maker • Kindle Fire

Florida Seller of Travel Numbers: ST39966 Postmarked By: 10/22/16

TERMS & CONDITIONS• Rebate forms are completely transferable, but may not be resold under any circumstances. Notice

of resell will void the rebate form.• Once your rebate form is received allow 7-14 business days* for processing and delivery. The

product you selected will be sent to you via the US Postal Service. Failure to adhere to all Terms & Conditions may hinder the processing of your rebate form. *Expect delays during National holidays.

• Offer not valid after postmarked date under any circumstance.• No duplicates of this rebate form will be accepted.• Failure to complete any line of this form will result in this rebate form being returned to you and

will cause a delay in processing.• Offer good on any mattress or set purchase of Beautyrest Black from Raymour and Flanigan -

9/9/16 to 9/26/16.

For questions related to the gift, please call 866-ELITE-21 or 866-354-83212 EASY WAYS TO REDEEM!1. Mail this, along with a photocopy of your sales receipt that includes the bed name, size, purchase date and price purchased to Elite Rewards · PO Box 261147 · Tampa, FL 33685 with the provided self addressed postage paid envelope.2. Scan your original receipt along with the completed form toinfo@selectgiftwithpurchase.com

Signature By signing this form, you hereby agree to all Terms & Conditions

for you

T hank You for your Beautyrest Black purchase with

Raymour & Flanigan& Beautyrest!

Bose Ear Buds Kindle Fire 7” TabletFitbit Flex Keurig Mini Coffee Maker