Request to Participate in Voluntary Sales Tax Refund Program

PRIVACY & RECORDS ACKNOWLEDGMENT To protect customer privacy and ensure compliance with applicable data security and medical privacy standards, I acknowledge the following: The company does not provide bulk transaction histories, cumulative purchase summaries, or printed purchase records at retail locations. I am responsible for providing my own physical or digital receipts issued at the time of purchase to support my submission. Submitted receipts will be used solely for the purpose of reviewing eligibility for this voluntary customer support program. NOTICE: PROTECTING CUSTOMER PRIVACY Regarding Record Requests To maintain the highest standards of data security and privacy, purchase history records will not be generated or distributed at the retail level. Why this matters: Because the company cannot furnish copies of customer receipts, please submit receipts already in your possession when you submit this application. Physical Receipts: Your original receipt reflects the taxes applied at the time of purchase. Digital Receipts: Receipts sent via email from point-of-sale or kiosk systems are also acceptable documentation. Privacy Commitment: Your purchase history may contain sensitive personal and/or medical information. Limiting access and distribution of these records helps protect your data. CUSTOMER ATTESTATION & PROGRAM TERMS By submitting this form, I acknowledge and agree to the following: I am the lawful purchaser associated with the submitted transactions and certify that all information provided is accurate and not fraudulent. This program is a voluntary customer support initiative. Submission of this form does not guarantee eligibility or issuance of loyalty credit. All submissions are subject to verification, review, and approval at the company’s discretion. If approved, loyalty credit may be issued in increments determined by the company and applied to my account for in-store use. Loyalty credit has no cash value, is non-transferable, and may be subject to standard program terms and conditions. The company reserves the right to deny, adjust, or revoke any submission that is incomplete, unverifiable, or inconsistent with program requirements. Processing timelines may take approximately 30 days from the date of submission, though timing is not guaranteed. Participation in this program constitutes a voluntary resolution of any claims related to the applicable tax period to the extent permitted by law.