Store Rebate Sales Reporting & Attestation Form

Fill out the form below to generate an Attestation Form with the populated data. After generation, the form will be automatically sent to Green Rebates.

Sales Data Summary

The following information must be submitted for all qualifying sales under this program.

Store Representative

By Signing below, the undersigned Store Representative attests and agrees to the following:

1. The information provided in this report is accurate and complete to the best of their knowledge.

2. All sales reported above were made to end-use customers during the active program period.

3. The customer received the full benefit of the rebate at the point of sale, as reflected in the final promotional price.

4. No more than two (2) qualifying fixtures were sold per customer, per location, per day, in compliance wih program requirements.

5. Only eligible products and SKUs listed on the current program schedule were promoted and invoiced.

6. All products were sold at approved store locations listed in Attachment A of the program schedule.

Failure to comply with these requirements may result in the rejection of rebate claims or removal from the program participation.