Customer Information:

First Name: _________________ Last Name: __________________

Address: (No P.O. Boxes please) __________________________________

Address Line 2: __________________________________________

City: __________________ State: __________ Zip: ____________

Email: __________________________________________________

Phone Number: _________________________________________

Terms and Conditions: Consumer is responsible for sales tax, only the purchase price will be refunded up to $5.00 for one Purex® Crystals ScentSplashTM fabric booster product. If coupon is used, amount of the coupon will be deducted from the purchase price and the actual price paid before taxes will be refunded. Requests must be postmarked by January 31, 2016. Void where taxed, restricted or prohibited. PO boxes will not be paid except in North Dakota. Allow six to eight weeks after mailing for delivery of your check. Limit one offer per envelope and one rebate per product/name/household/address. The Dial Corporation, A Henkel Company reserves the right to confirm identification. Fraudulent submissions could result in federal prosecution under US Mail fraud statutes (18 USC Sections 1341 and 1342). © 2015 The Dial Corporation, A Henkel Company To check the status of your rebate, please visit www.rapid-rebates.com or call 1-800-619-4703

PUREX® CRYSTALS SCENTSPLASHTM FABRIC BOOSTER

TRY FOR FREE OFFER

Rebate Instructions:

To receive a rebate check up to $5.00, mail the following two items to the address provided by 1/31/16:

1) The original, store identified cash registerreceipt dated 5/15/15 to 12/31/15 with qualifying purchase and price circled

2) This completed official rebate form Receive: A rebate check for up to $5.00 by mail. Allow 6-8 weeks for delivery of your check.

PUREX® CRYSTALS SCENTSPLASHTM

FABRIC BOOSTER – TRY FOR FREE OFFER Dept #: DH15-1908PO Box 472Scottsdale, AZ 85252-0472

In the area below, please write the 12-digit UPC bar code number from the product package for your claim to be valid:

0 - 24200 -__ __ __ __ __ - __

YES, please send me future coupons and offers from The Dial Corporation.

1). Is this your first purchase of Purex® Crystals ScentSplashTM fabric booster? Yes No

2). What similar products have you tried in the past? ________________________________________________________________

3). What interested you to buy? ___________________________________________________________________________________

Receive a rebate on your Purex® Crystals ScentSplashTM fabric booster purchase Simply complete this form and mail it with your original store identified receipt to: