Rebate 20% | Electrolux Front-Loading Washers Settlement

Electrolux Front-Loading Washer Settlement - 20% Rebate Form

INSTRUCTIONS: Complete the entire Rebate Certificate below. This Rebate Certificate can be applied toward the purchase of any new Electrolux-manufactured product listed on the Appliance Options List, available by clicking here.

This Rebate Certificate has no cash value and must be submitted within one (1) year after the date of issuance. You must include documentation demonstrating proof of purchase of an Electrolux-manufactured product listed on the Appliance Option List with your Rebate Certificate.

PLEASE UPDATE YOUR MAILING ADDRESS (IF APPLICABLE)

Address 1

Address 2

City

State

Zip Code

PLEASE ENTER YOUR EMAIL ADDRESS

Email Address *

INFORMATION ABOUT YOUR REBATE-ELIGIBLE ELECTROLUX-MANUFACTURED PRODUCT

Please complete all fields and attach your proof of purchase that reflects this information.

Date of Purchase *

Best Negotiated Retail Price Paid *
Do not include sales tax, delivery fees or installation charges.

SKU/Model Number *

Serial Number *

Upload Proof of Purchase

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

Select File for Upload:

File Description:

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CERTIFICATION STATEMENT

(Please note that you will not be eligible to receive any rebate benefit unless you sign and date this statement):

I affirm under penalty of perjury under the laws of the United States that all information and documents provided in connection with this Rebate Certificate are true and accurate. *

Signature *

Date

TRANSFER OF REBATE CERTIFICATE

Complete this section ONLY if you are transferring the rebate to another household or immediate family member. Leave this section blank if you are not transferring the rebate. Proof of relationship and/or proof demonstrating the same household may be required.

Check is box if you are transferring your Rebate Certificate *

Wendy Grasso and Nicholas Grasso, on behalf of
themselves and all others similarly situated v.
Electrolux Home Products, Inc.

Case No. 8:16-cv-00911 (M.D. Fla.)

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Electrolux Front-Loading Washer Settlement - 20% Rebate Form

Your Rebate has been submitted successfully.

Rebate Number:
Rebate Code:
REBATE INFORMATION
Name
Address 1
Address 2
City
State
Zip Code
Email Address