Loyalty Health Program Nature’s Logic™ Free Product Request Form Fill out completely and mail in with receipts and Proof of Purchase UPC’s of all 10 products purchased to: Nature’s Logic™ Loyalty Health Program PO Box 67224 Lincoln, NE 68506-7224 Allow 2-3 weeks to receive a coupon for free product of the same size and category. Coupon can only be redeemed at the store indicated on the Free Product Request Form.

NAME: ____________________________________________________________________________________

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STREET ADDRESS (NO P.O. BOXES)

CITY: ______________________________________________________________________________

STATE/PROVINCE: _______________________________    ZIP: __________________________

STORE WHERE PRODUCT WAS PURCHASED: ____________________________________________________

STREET ADDRESS: ______________________________________________________________________________

CITY: ______________________________________________________________________________

STATE/PROVINCE: _______________________________    ZIP: __________________________

OPTIONAL INFO:

TOTAL NUMBER OF PETS: ______________  DOGS: __________________  CATS: __________________

EMAIL ADDRESS: _______________________________________________

COMMENTS: _________________________________________________________________________________

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NOTE: The Nature’s Logic™ Loyalty Program cannot be used in addition to any store managed frequent buyer programs.