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Fill out the form below to receive a $2.00 coupon good for any Zantac^® purchase. You'll also be the first to find out about money-saving offers, new games, videos and site updates.

You must be 18 years of age or older to register. Thank you for your interest in Zantac^®.

Limit 1 coupon per household.

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The information you are about to provide is being collected by Boehringer Ingelheim Pharmaceuticals, Inc. so that we may advertise our products to you and provide you with information about them.

Boehringer Ingelheim Pharmaceuticals, Inc. respects your right to have personal and medical information kept confidential. Boehringer Ingelheim Pharmaceuticals, Inc. and companies working with Boehringer Ingelheim Pharmaceuticals, Inc. will use the information you provide, as well as information from redeemed coupons and/or vouchers we have provided you, which we receive from the pharmacy, to fulfill your request and to help develop products, services, and programs. It will not be shared with any other third parties (such as mailing lists).

	By checking here and clicking Submit below, you indicate that you agree to the above and want us to use the information you have provided to send you information and offers related to Zantac^® from time to time.
	By checking here and clicking Submit below, you indicate that you agree to the above and allow us to use your information to advertise Zantac^® and other products to you. Boehringer Ingelheim Pharmaceuticals, Inc. may also provide you with useful materials and contact you about health-related topics.

If you do not check either box, we will fill just the one-time request.
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