To receive your rebate, ALL 4 requirements must be met. Send:

The original Pharmacy prescription receipt with purchase price circled
(no cash register receipt)
The box bottom with UPC code from each box of Lustra family product purchased
This official mail-in certificate filled out completely
Mail to: LUSTRA Family up to $50 Rebate
P.O. Box 2227
Ocean, NJ 07712-2227

I have complied with all the terms of this offer. By my signature, I certify that I am not being reimbursed for this product by Medicare or Medicaid, any other federal or state program, including any state pharmaceutical assistance program.  I further certify that I am not reimbursed for this product by any other private third-party payers that reimburse me for the entire cost of my prescription drugs.  I also understand that I am responsible for any reporting or other requirements with respect to receipt of this rebate.

Signature: ____________________________________________________________
(Must be signed in order to be valid)

Rebates are not valid for prescriptions reimbursed under a federally funded health care progeram, including Medicaree or Medicaid, as well as similar state programs, including any state medical assistance programs.  Rebates are also not valid for private insurance plans that reimburse you for the entire cost of your prescription drugs.  This rebate is up to $50, or the amount of your co-pay, whichever is less. Offer void where prohibited by law, taxed or restricted.  Offer good only in the U.S.A.  Manufacturer reserves the right to rescind, revoke or amend this offer without notice. Offer not valid for prescriptions filled through GE Pharmacy.

LUSTRA-ULTRA® (hydroquinone USP 4%), LUSTRA-AF® (hydroquinone USP 4%), and LUSTRA® (hydroquinone USP 4%) are indicated for the gradual treatment of ultraviolet-induced dyschromia and discoloration resulting from the use of oral contraceptives, pregnancy, hormone replacement therapy, or skin trauma.

Important Safety Information: Hydroquinone may produce unwanted effects if not used as directed. Occasional skin irritation may occur. LUSTRA-ULTRA, LUSTRA-AF, and LUSTRA should be tested for skin sensitivity prior to use. Excessive inflammatory responses are contraindications for further use, while minor redness is not. Contact with eyes should be avoided. Warning: LUSTRA-ULTRA, LUSTRA-AF, and LUSTRA contain sodium metabisulfite, which may cause serious allergic reactions (eg. hives, itching, wheezing, anaphylaxis, severe asthma attack) in certain susceptible persons.