Online Rebate Form

Get reimbursed for qualifying snack and drink products with the purchase of qualified Selectivend vending machines from samsclub.com.

This rebate offer is good while funds are available and may be subject to change without prior notice. All rebate requests must submitted via the online rebate form at: URL within six months of the vending machine purchase date. Rebates will only cover up to the actual purchase price of the items and excludes sales tax, shipping and deposits. Only one rebate request per eligible vending machine may be submitted, therefore please do not submit your rebate request until you are ready to submit the rebate in its entirety.

To be eligible for this rebate, all snack and drink products must purchased from a Sam’s Club location or online at samsclub.com. Only qualifying snack and drink products are eligible for reimbursement and these qualifying products are subject to change without prior notice.

Rebate New 060522
Sam’s Club store location you purchased your snack and drink rebate products from
Select the store location from where you bought the snack and drink products from. If you purchased the products online, please select the Sam’s Club location closest to your home address.

Your Information

Name
Name
First
Last

Select Your Machine

Selectivend Advantage Plus ADA Compliant Combo Vending Machine

Machine Serial # is located on the back top corner of the machine.

Selectivend CB500 Gatorade 10 Selection Drink Machine

Machine Serial # is located on the back top corner of the machine.

Selectivend SV3000 Vending Machine

Machine Serial # is located on the back top corner of the machine.

Selectivend WS4000 32 Selection Snack Machine

Machine Serial # is located on the back top corner of the machine.

Selectivend WS5000 40 Selection Snack Machine

Machine Serial # is located on the back top corner of the machine.

Select Your Rebate Eligible Snack and Drink Products

Please do NOT include sales tax, shipping costs, or deposits in the product purchase price.
1) If you have multiple receipts, please input each product from each receipt separately.
2) If you paid difference prices for the same product, please add each product on a separate line.

Gatorade or Tropicana or Propel
(Max 25 cases/machine)

$
$9 to $18
MM/DD/YYYY

Bottled Water – Nestle Pure Life or Member’s Mark (MM)
(Max 58 cases/machine)

$
$2.50 to $5.50
MM/DD/YYYY

Lance Toasty Sandwich Crackers
(Max 8 cases/machine)

$
$5 to $10
MM/DD/YYYY

Lance ToastChee Peanut Butter Crackers
(Max 8 cases/machine)

$
$5 to $10
MM/DD/YYYY

Lance ToastChee Cheddar Crackers
(Max 8 cases/machine)

$
$5 to $10
MM/DD/YYYY

Lance Cream Cheese and Chives Crackers
(Max 8 cases/machine)

$
$5 to $10
MM/DD/YYYY

Lance Sandwich Crackers, Variety Pack
(Max 8 cases/machine)

$
$8 to $12
MM/DD/YYYY

Synder’s Mini Pretzels
(Max 13 cases/machine)

$
$10 to $15
MM/DD/YYYY
Maximum upload size: 52.43MB
Upload only JPG/PDF

summary
Total Case Quantity
Total Rebate Amount
Gatorade / Tropicana / Propel
$
Bottled Water – Nestle Pure Life or Member’s Mark
$
Toasty Sandwich Crackers
$
ToastChee Peanut Butter Crackers
$
ToastChee Cheddar Crackers
$
Cream Cheese and Chives Crackers
$
Sandwich Crackers, Variety Pack
$
Synder’s Mini Pretzels
$
Grand Total
$
******Rebates are allowed on approved amount(s) only. Rebate submission requires auditing for accuracy. The approved amount will be submitted to the participating suppliers only after complete review of the rebate claims. If discrepancies are found in the rebate claim, Selectivend will notify you of those discrepancies. Selectivend will then reconcile the claim and submit your rebate to the suppliers. If you have any questions regarding your rebate please contact Selectivend at 800-323-8793 or clubsales@selectivend.com. Thank you! *******
Why not protect that investment with an Extended Warranty?
You will receive a thank you notification via email once your rebate application has been successfully received.
Call to Order Now! (800) 282-1944
Selectivend, Vending Machines, Des Moines, IA