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This Samsung exchange rebate* applies to the purchase of a new washer. You will receive $ toward the purchase of a new Samsung Washer or $ toward the purchase of a washer from another manufacturer, subject to the Eligibility Requirements set out below.

* The rebate value cannot exceed the price of the new washer. The rebate amount is valid from November 5,2020 to November 4,2021,after which time the rebate amount will be adjusted. For any purchase made after November 4th,2021 a new rebate form will need to be requested which will have a reduced rebate amount.

TO RECEIVE YOUR REBATE:

1. Purchase and take delivery of a new washer from any retailer.
2. Indicate the appropriate rebate choice from the 2 choices below by filling in the circle.
3. List the brand, model number, and serial number of your new washer in the space provided below.
4. Affix the two (2) Model/Serial Number labels from your recalled Samsung washer to the grey boxes at the bottom of this page. If your washer has only one (1) Model/ Serial Number label, take a picture of the back of the washer, then remove the label, and affix it below. When you mail in this form, include a copy of the picture.
   Important: Do not remove the Model/Serial Number labels from your new washer.
5. In the Certification box below, print your name, and then sign and date the form to certify that your recalled washer has been properly discarded (or delivered for disposal), that it is no longer in use, and that the label(s) you have affixed are from your recalled Samsung washer and that you acknowledge that it is a violation of federal law to sell or distribute in commerce a recalled washer.
6. Mail this page, signed and dated, with the Model/Serial Number labels from your recalled Samsung washer, the picture of the back of the washer if you have ony 1 label, and the original receipt from your new washer to:
   
   Samsung TLW Rebate Program c/o Stericycle
   6026 Lakeside Blvd. Indianapolis, IN 46278
   
   

Note: Make a photocopy of the receipt from your new washer and this page for your records. Verify that the information below is correct. If changes are needed to the information below, call 866-264-5636.

Samsung Washer Purchase Other Manufacturer Purchase

Brand: 

 

Model #: 

 

Serial #: 

 

Model Number:  Serial Number: 

Customer's Name: 

Email: 

Address: 

Rebate: 

Phone: 

Expiration Date:  November 4,2021

Certification: I certify that I have properly discarded (or delivered for disposal) my recalled Samsung washer and that it is no longer in use. I acknowledge that it is a violation of federal law to sell or distribute in commerce any recalled washer. I also certify that the Model/Serial Number labels from my recalled Samsung washer are affixed below.

Print Name: 

 

Date: 

 

Signature: 

 

Do Not Mail This Page

Before you mail this form, please remember to:

• Select the rebate you are applying for – Samsung washer or Other Manufacturers washer.
• List the brand, model number, and serial number of your new washer in the space provided.
• Affix the one (1) or two (2) Model/Serial Number labels from your recalled Samsung washer to the rebate form. If your washer had only one label, make sure to include the picture of the back of the washer.
• Sign the Rebate Form certifying that you have discarded the recalled Samsung washer, that it is no longer in use, that the label(s) you affixed to this form are from your recalled Samsung washer, and acknowledging that it is a violation of federal law to sell or distribute in commerce any recalled washer.
• Include the original sales receipt for the new washer.
• Make a photocopy of the receipt from your new washer and page 1 for your records.

How to Locate the Model and Serial Number Labels (Label 1 is located in one of the two locatiosbelow):

  

Please allow 4 to 6 weeks from the submission of this form for receipt of your rebate. If you do not receive a response by the end of that period, call the Samsung Rebate Response Line at 866-264-5636 for the status of your rebate.

If you have any additional questions, contact us at 866-264-5636, 9:00am to 6:00pm EST,Monday through Friday, Saturday/Sunday:Closed

Eligibility Requirements

1. This rebate offer is available to all Samsung washer owners in the United States who have a Samsung Top- Load washer covered by the recall announced on November 4th, 2016 and is subject to the terms thereof. Go to www.Samsung.com/US/TLW for details. This rebate is restricted to U.S. customers only.
2. The rebate dollar amounts shown on the rebate form are valid from November 5^th,2020 to November 4^th,2021 . The expiration date is also shown on page 1. The new washer must be purchased by this date. If your rebate expires, you will need to request a new rebate form, which may have reduced rebate amounts.
3. The rebate form must be submitted no later than 30 days from the delivery date of the replacement washer.
4. The rebate form must be accompanied by:
   1. The original sales receipt of the replacement washer.
   2. The one (1) or two (2) Model/Serial Number Labels from the recalled Samsung washer. The Serial Number must be clear and legible. If your washer has only 1 Model/Serial Number Label, you must include a photo of the back of the washer showing the single label.
5. The Certification Area must be signed and dated.
6. Rebate eligibility requirements are subject to change without notice, including early termination of the rebate program.
7. Samsung will reimburse you for any installation or removal fees incurred by the delivery of your new washer if they are listed as separate line items on the sales receipt. Custom installation charges or accessories are not included.
8. Samsung will provide only one rebate per recalled washer with a limit of two rebates per household.
9. The rebate amount may not exceed the price of your new washer. If the price of your new washer is less than the rebate amount shown on page 1, we will only provide a rebate equal to the price of the new washer.
10. If you selected the free in-home repair option offered on our recall web site and the repair has been performed, you are not eligible for this exchange rebate.