PenSimple - Rebate Form
REBATE GUIDELINES
- "Proof of Purchase" is required - a receipt from the store
- Rebates can be filed no later than 30 Days from the time of purchase (filing date based on postage date)

REBATE STEPS
1. Please fill out this form. An email confirmation is provided after submission.
2. Send a picture of your receipt to: paul@getpensimple.com
3. Print either: the rebate confirmation email or a screenshot of it
4. Mail-in the rebate confirmation to:
JAEB Designs
PO Box 20612
Boulder CO 80301
5. Please wait 6-8 weeks for your check to be mailed to you

Email address *
Full Name
This is the name the check will be made out to
Your answer
Street Address 1
This is where the check will be mailed to
Your answer
Street Address 2
This is where the check will be mailed to
Your answer
City
This is where the check will be mailed to
Your answer
State
This is where the check will be mailed to
Your answer
Postal Code
This is where the check will be mailed to
Your answer
What store did you buy from?
To ensure this was an authorized retailer
Your answer
How many PenSimples did you purchase?
Your answer
Date of Purchase
MM
/
DD
/
YYYY
Additional Feedback / Concerns
If you had any issues filling out this form, please include your concerns here
Your answer
A copy of your responses will be emailed to the address you provided.
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