Mail-In Rebate

Mail Submissions to:

USRobotics - Offer #11031a

PMB#389

119 S. Emerson St.

Mount Prospect, IL 60056

Name

Address

City/State

Zip Code

Phone

E-Mail (optional)

 USRobotics® may occasionally communicate information about new products or special

offers with our best customers. If you want to receive this information, check this box.

Sample Serial Number Sample UPC Code

Get a $10 Visa

™

Debit Card from USRobotics

the purchase of a USRobotics V.92 PCI Software

Faxmodem.

USRobotics

V.92 PCI Software Faxmodem

USR5670

Requests must be postmarked by 4/30/11. Limit one rebate per product per household/address. Of-

fer not valid at Fry’s Electronics. Requests from groups will not he honored. Fraudulent submissions

or multiple requests could result in prosecution. Offer valid in the United States and Puerto Rico only.

Void where prohibited, taxed or restricted by law.

If you do not receive your debit card within 8-10 weeks, check its status by calling

1 (866) 994-3861. Debit cards are void if not used within 60 days of issuance and cannot be reissued.

Please keep copies of all materials submitted for your records. Maximum rebate amount is $10.

NOT VALID WITH ANY OTHER OFFERS.

$10 Visa

Debit Card Mail-In Rebate Offer good between 1/1/11 and 3/31/11

To receive your $10 Visa

Debit Card rebate:

1) Purchase the featured USRobotics Faxmodem between 1/1/11 and 3/31/11

2) Fill in all requested information on this rebate form.

3) Mail all of the following items:

 this completed form

 the original UPC code cut from the product package

 the serial number cut from the product package

 a copy of your dated sales receipt