TBC $75 Rebate Submission Form

Citi

Rebate Form.BSE Rebate Submission Form.052021 002 
BRANDSOURCE®
VISA® PREPAID CARD REBATE OFFER

GET A
$75* VISA PREPAID CARD
by mail-in or online rebate on purchases of $3,499 or more when using the BrandSource Credit Card.

MAY 20 ­ JUNE 9, 2021

The following steps need to be completed to receive either a $75 BrandSource Visa Prepaid Card* by mail-in or online rebate.
STEP 1 Make a qualifying purchase between 5/20/21 through 6/9/21 on the BrandSource Credit Card. Check the amount purchased: $3,499 or more to receive a $75 Visa Prepaid Card*
STEP 2 Submit online today at: brandsourcecardrebate.com OR
For mail-in or fax submissions, please fill in the required information below. (If your rebate submission is approved the Visa Prepaid Card will be sent to the address provided on this form.):
Name
Address

STEP 3 Mail a copy of your invoice and this completed original form by 7/9/2021 to: BrandSource Rebate Department #750000 P.O. Box 1919 Memphis, TN 38101
OR
submit by fax to: 1-901-345-8812

CUSTOMER COPY

STORE

DETAILS

BRANDSOURCE TEST-39999

Date:

4/2/2019

SAMPLE 50 NORTHWEST POINT RD
ELK GROVE VILLAGE, IL 60007 2245551212 SystemId: RONBSJR1
PROMOTION DEF INT FOR 6MOS-PMT REQ, 0600 TOTALS

Transaction Type: Invoice #: Reference #: Cardholder Name: Account #: Authorization #: RequestId:

Sale RONTEST
JANICE WEBER ************9687 002609 01Z6H578V000P747LTV12GH74B6R0A6O

Subtotal + Tax
Grand Total

$300.00 $0.00
$300.00

City

sample receipt

State

Zip

Last 4 digits of account #

Phone

Product Purchased

Store Name

PLEASE KEEP A COPY OF THIS FORM FOR YOUR RECORDS.

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*Subject to credit approval. Offer valid on any purchase of $3,499 or more made in a single transaction from 5/20/21­6/9/21 to receive a $75 Visa prepaid card. Complete purchase must be made on the BrandSource Credit Card. Not valid on prior purchases. One rebate per visit. Cannot be combined with other credit card offers. Valid at participating BrandSource locations. Completed rebate form must be postmarked by July 9, 2021. Visa prepaid card is given to you as a rebate and no money has been paid by you for the card. Visa prepaid card is issued by MetaBank®, N.A., Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Visa prepaid cards expire after 6 months; unused funds will forfeit after the valid through date. Visa prepaid card terms and conditions apply. If Visa prepaid card is not received after 8 weeks, call 1-877-853-2504 (TTY: 711) to inquire about status. MetaBank or Visa does not sponsor or endorse BrandSource Credit Card or this offer. BrandSource Credit Card is issued by Citibank, N.A. BRANDSOURCE REBATE #589600
BSE-REB-FORM-0321
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