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Name of offer: Epiquin® Micro Rebate
Type Of Program: Rebate; you print the rebate form from your computer.
This is a simple procedure. Click HERE to reach the rebate form and print it on your computer.
Print the certificate and follow the instructions below after filling your EpiQuin Micro prescription:
Circle the price you paid on the original pharmacy receipt (not the register receipt).
Make sure the receipt has the following information:
Date
Physician name
Your name
Name of the pharmacy
* Sign the certificate acknowledging you meet the offer criteria, and submit this form along with the dated pharmacy receipt.
Send to:
TRIALCARD
6501 Weston Pkwy, Ste 370
Cary, NC 27513-9967 In 10-14 working days you will receive a check for up to $20.00, or your out-of-pocket co-pay, whichever is less.
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