Name of Distributor where purchased: _____________________________

Name:_____________________________________________________

Company Name:_____________________________________________________

Company Address:___________________________________________________

Phone Number:____________E-Mail Address (Must Have)______________

Catalog Numbers of Labels / Holders Purchased	Quantity	Total $
Total $

Signature:_________________________ Date:_________________________

Terms and Conditions:
1. Complete promotion form and attach original invoice with purchases circled.
2. Only unaltered original dated invoices with purchase Hubbell labels or holders circled, accompanied by this submission form, will be accepted.
3. Submission form MUST be completely filled out to be eligible for the promotional offer.
4. Requester must include e-mail address for delivery
5. Submission of false or altered documentation will result in the loss of any rights to this promotion.
6. Purchase of labels or holders must be made through an authorized Hubbell distributor.
7. Hubbell reserves the right to verify any and all documents.
8. This offer is available in the United States of America only.
9. Hubbell is not responsible for lost, late, non-delivered, misdirected promotion e-mails.
10. This offer cannot be used in conjunction with any other promotions or special offers.
11. This promotion is for contractors who install the Hubbell Premise Wiring Solutions. Hubbell employees and Hubbell distributors are not eligible.

Fax promotion form to Hubbell Premise Wiring @ 860-535-8328