Recharge Base & Rebate Form

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Which type of Doppler did you purchase?
Contact Name
Shipping Address
Will the recharge base be sent to the name/address above?
Will the rebate check be sent to the name/address above?
Reasons for purchasing:

Offer cannot be combined with any other Newman Medical discount, offer, or GPO contract pricing. Offer valid in the U.S. only. Only 1 rebate per purchase. Please print legibly and allow 2-4 weeks for rebate after receipt of recyclable Doppler and form.