Allegra (fexofenadine HCl) 60mg capsules

You can save up to $5.00 with a rebate on your next purchase of Allegra^® or Allegra-D^® (fexofenadine HCl 60 mg/pseudoephedrine HCl 120 mg) extended-release tablets. Consider it our way of saying thanks for being an Allegra patient.

After filling your prescription for any Allegra^® product, print this page out from within your Web browser (may be more than one page when printed from your printer), complete the form below and mail your answers on the printed pages along with your proof of purchase (original pharmacy receipt) to:

Allegra $5 Web Offer
PO Box 29271
Shawnee Mission, KS 66201-9697

LIMITATIONS: This Web page must accompany this request. Print out this page (may be more than one page when printed from your printer) using the print option in your browser, answer the questions, and send them in with your proof of purchase (original pharmacy receipt). Proof of purchase will not be returned. This is a prescription product; therefore, a prescription must have been filled in order to use this certificate. The redemption amount is considered a discount on the purchase price of the product. Not valid for prescriptions covered by Medicare, Medicaid, or similar federal or state health care programs. Amount of rebate not to exceed $5.00 or copay, whichever is less, and shall not be submitted to any third-party payer, public (e.g., Medicaid) or private, for reimbursement. Void where prohibited by law. Void outside the U.S.A. or if taxed, restricted, prohibited, assigned, reproduced or transferred. It is illegal for any person to sell, purchase, or trade or offer to sell, purchase, or trade or to counterfeit this certificate. Limit one rebate per person per 12 months. Please allow 4-6 weeks for delivery of your rebate check. Void after December 31, 2000.

Name	______________________________

Address	______________________________

City, State, Zip	______________________________

Gender. Check one:

1. Male

2. Female

What is your date of birth?

____ - ____ - _______

Which ALLEGRA^® product did you purchase with this offer? Check one:

1. Allegra^® 60 mg Capsules

2. Allegra-D^®

Please indicate the number of times you have filled an ALLEGRA^® prescription in the last 12 months. Check only one.

1. 0	3. 4-7
2. 1-3	4. 8 or more

Check the seasons during which you suffer from seasonal allergies. Check all that apply:

1. Summer

2. Spring

3. Fall

4. Winter

How many days, per year, do you, yourself, medicate/take medicine (prescription or over-the-counter), to relieve allergy symptoms? Check only one:

1. 1 - 30 days

3. 61 - 120 days

2. 31 - 60 days

4. 121 days or more

Which of the following are you allergic to? Check all that apply:

1. Grass
3. Weeds

2. Trees

What allergy medication(s) have you taken in the past year? Check all that apply:

1. Allegra^®
2. Allegra-D^®
3. Benadryl^®
4. Chlor-Trimeton^®
5. Claritin^®
6. Claritin-D^®
7. Flonase^® 8. Hismanal^®
9. Tylenol^® Allergy/Sinus
10. Vancenase^®
11. Zyrtec^®
12. Other
13. None

Other than yourself, do any other members of your household suffer from seasonal allergies? Check all that apply:

1. Spouse

2. Child 12 or older

3. Other

4. No one else suffers from allergies

Would you like to receive an e-mail message from us when we have special offers or news about Allegra?

Yes

If Yes, please check your audience type.

consumer

media professional

health care professional

If Yes, please provide us with your e-mail address.

E-mail address: _____________________

Would you like to have the AllerDays^® newsletter mailed to your home through postal mail?

Yes No

Would you like to have the AllerDays^® newsletter e-mailed to you?

Yes No

E-mail address: _____________________

Allegra Product Information | Allegra-D Product Information

Benadryl is a registered trademark of Warner-Lambert Company. Chlor-Trimeton, Claritin, Claritin-D and Vancenase are registered trademarks of Schering Corporation. Flonase is a registered trademark of Glaxo Group Limited. Hismanal is a registered trademark of Janssen Pharmaceutica, N.V. Tylenol is a registered trademark of Johnson & Johnson. Zyrtec is a registered trademark of UCB, Societe Anonyme.

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Allegra (fexofenadine HCl) 60mg capsules - for nondrowsy relief of Seasonal Allergic Rhinitis Info
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