*See submission instructions and offer/payment

terms and conditions on the back of

this form.

Name: _________________________________________________________________

Address: _____________________________________________ Apt/Ste : ___________

City: ____________________________________ State: ______ Zip: ____________

Phone #: ___________________ Email: _______________________________________ SUPPLYING YOUR EMAIL ADDRESS WILL ALLOW US TO COMMUNICATE YOUR REBATE STATUS

Receive a $1 Rebate on the purchase of one (1) gallon of

SPLASH RV & Marine Antifreezeat participating locations September 1 - 30, 2016.

Submissions must be postmarked/submitted within 14 days of your purchase. Complete the required information below and provide the part numbers for the purchases shown on your receipt.

SPLASH RV & MARINE ANTIFREEZE, 1 GALLON (OFFER # FM1015) $1 rebate per gallon, up to $6 total (6 gallon max.)Eligible Part # 619526 & 619527

Part #: ________ Quantity: ___ | Part #: ________ Quantity: ___

IMPORTANT: Please make sure that your purchase receipt shows the qualifying part numbers for each rebate item. They may be hand-written on the receipt, if necessary.*

Qualifying products must be purchased at participating locations September 1 - 30, 2016. Submissions must be postmarked/submitted within 14 days of your purchase.

TO ENSURE WE IDENTIFY THE ALL OF QUALIFYING ITEMS ON YOUR RECEIPT:- Make sure that your purchase receipt

shows the qualifying part numbers for each rebate item. They may be hand-written on the receipt, if necessary. Contact the retailer to obtain the part numbers if needed.

- Write qualifying part #s on the front of the form before mailing or digitally uploading the form with your receipt.

- Circle all qualifying parts on your detailed purchase receipt.

Submit front of form and receipt online at FMPRebates.com or mail this completed claim form and the dated sales detailed receipt (credit card receipts are not valid proof of purchase) with qualifying products circled to:

FMP RebatesOffer #FM1015P.O. Box 130021

El Paso, TX 88513

Limit one (1) per rebate, up to 6 gallon maximum, per customer or purchase receipt. for the length of the promotion.

Go to FMPRebates.com to check the status of your rebate. For questions/further inquiries about your rebate or the processing of your rebate, please call 866-955-6095.

TERMS AND CONDITIONS: Place this completed rebate claim form and dated sales receipt from participating locations, with qualifying parts circled, in an envelope and mail to address listed above. All required information on this form must be hand printed; no copies or other mechanical reproductions will be allowed. Offer is limited to one (1) rebate, for up to 6 gallons, per customer or purchase receipt for the length of the promotion. No group or organization requests will be honored. Use of multiple addresses or P.O. Boxes to obtain additional rebates is fraud and may result in prosecution. Keep copies of materials submitted; originals submitted become vendor’s property and will not be returned. Incomplete or illegible rebates and claims that do not comply with the terms and conditions of this offer will be rejected and not returned. Vendor has the right to substantiate services and sales receipts. Dealers, distributors and other resellers are not eligible for this offer. Offer good in the USA only. Rebate will be mailed to a USA street address. Allow up to 8 weeks for rebate processing. Void where prohibited. Vendor is not responsible for lost, late, destroyed, stolen, misdirected, incomplete, illegible, postage due or undeliverable mail, nor for misprints or typographical errors. By submitting this rebate, you have read and agreed to the rebate terms and requirements. Vendor reserves the right to terminate, withdraw, or amend the promotion for any reason without notice.

ALL QUALIFYING REBATES WILL BE PAID VIA A REBATE CHECK.