ATTACH RECEIPTS. To Expedite Processing Please or Fax Your Cash Back Form to: Or Fax Your Claim to:

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1 How to File a Cash Back Form To receive your Cash Back from purchases made through the Kidney & Urology Foundation of America, Inc. s web portal you must submit a Cash Back form along with the receipts for your transactions. Here are the steps to follow: 1 COMPLETE FORM 2 ATTACH RECEIPTS 3 SEND FORM TO UHY ADVISORS The Cash Back form MUST be completed in its entirety with all supporting receipts. Failure to do so may result in a forfeiture of your Cash Back. Credit Card Receipts or canceled checks are not adequate documentation. Since UHY Advisors does not receive credit card or personal information we require the receipt in order to process your rebate. You may submit up to eight (8) transactions on a single Cash Back Form, using a separate line for each purchase. DO NOT include Tax and Shipping costs in your order total. The percentage of Cash Back is calculated based upon the merchandise total only. Place documents in this order: Cash Back Form first, then the supporting documentation. Please do not return the instruction pages with your Form and Receipts. To Expedite Processing Please or Fax Your Cash Back Form to: Or Fax Your Claim to: Mail to: UHY ADVISORS Shop 4 Rewards, PO BOX 1035 Oakland, NJ 07436

2 How to File a Cash Back Form: COMPLETE FORM 1 COMPLETE FORM Shop 4 Rewards Cash Back Form Tips to Remember: 1. Forms must be submitted within 90 Days of the purchase/transaction date in order to receive Cash Back 2. No more than 8 transactions per submission form each form must be filled out in its entirety 3. Be sure to include the date(s) of the transaction(s) along with the receipt(s) 4. Keep a copy of all receipts for your files Customer Information (please print) Name: Kidney & Urology Foundation of America, Inc. Group Name: Address Any Town Any State City: State: Zip: Phone: Address: Cash Back Purchases Date Of Purchase Purchase Price (excluding tax & shipping) Month/Day/Year 05/ 16 /2009 Macys.com $ To Expedite Processing Please Your Cash Back Form to: Or Fax Your Claim to: Mail to: UHY Advisors Shop 4 Rewards, PO BOX 1035 Oakland, NJ Please note: Receipts must be submitted within 90 Days of purchase. Incomplete forms may result in forfeiture of Cash Back

3 How to File a Cash Back Form: ATTACH YOUR RECEIPTS 2 ATTACH RECEIPTS ORDER INFORMATION ORDER NUMBER BILLING ADDRESS Anytown, US USA Date of Purchase PLACED ON: 5/16/2009 SHIPMENT ADDRESS 1 SHIP TO TOTALS Anytown, US USA Merchandise Total: $ Standard Shipping: $21.95 Sales Tax: $15.88 Order Total: $ Amount Tendered: --- MASTERCARD ************7823 $ Merchandise Total DO NOT include Shipping and Tax

4 How to File a Cash Back Form: SEND TO UHY ADVISORS 3 SEND FORM TO UHY Submit your Cash Back Form to UHY Advisors via one of the following methods: Fax: Mail: UHY Advisors Shop 4 Rewards PO BOX 1035 Oakland, NJ 07436

5 Shop 4 Rewards Cash Back Form Tips to Remember: 1.Forms must be submitted within 90 Days of the purchase/transaction date in order to receive Cash Back 2.No more than 8 transactions per submission form each form must be filled out in its entirety 3.Be sure to include the date(s) of the transaction(s) along with the receipt(s) 4.Keep a copy of all receipts for your files Customer Information (please print) Name: Kidney & Urology Foundation of America, Inc. Group Name: Address City: State: Zip: Phone: Address: Cash Back Purchases Date Of Purchase Month/Day/Year Purchase Price (excluding tax & shipping) Please check here if you would like 100% of the cash back generated to go to the Kidney & Urology Foundation of America, Inc. To Expedite Processing Please Your Cash Back Form to: Or Fax Your Claim to: Mail to: UHY Advisors Shop 4 Rewards, PO BOX 1035 Oakland, NJ Please note: Receipts must be submitted within 90 Days of purchase. Incomplete forms may result in forfeiture of Cash Back Shop4Rewards Customer Service department:

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