Online Rebate Submission

1User Details > 2Upload Files
User Information
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone [Do not use space, -, + or ( )]
Email
PLEASE NOTE: This application is valid only for rebates that are less than $15 value. All rebates over $15 needs to be physically mailed to one of your closest NeilMed office location. Any rebates over $15 which are uploaded online will not be processed.