To receive your rebate offer of $10.00, for the purchase of Dr. Scholl??s? Custom Fit?? Orthotic Inserts, you must:
??? Buy one Dr. Scholl??s? Custom Fit?? Orthotic product between January 15, 2010 and April 30, 2010.
??? By no later than May 31, 2010, mail this form along with the original UPC from product package* and the original store
cash register receipt, dated between January 15, 2010 and April 30, 2010 with your product purchase and price circled.

Your rebate request, including all required materials, must be postmarked by May 31, 2010. Limit four per household, address and/or name.

http://www.footmapping.com/cfo_rebate_form.pdf