Redemption Inquiry Form

Redemption Inquiry Form

Complete this form for an update on your coupon redemption.
Before submitting this form, please make sure that:
- It has been at least 4 weeks since you mailed your FMNP or FreshConnect coupons
- It has been at least 8 weeks since you mailed your NYC Health Bucks
If you answered yes, submit this form with as much information as you can and we will be in touch with you.

Please note that we will often pay out different programs separately in order to get funds to you more quickly. Please make sure that the amount you're calling for hasn't been paid separately.
Name*

First NameLast Name
Business Name*
FMNP #
4-digit stamp #
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Redemption Form Date:*

MonthDayYear
Please enter the date on your redemption form.
Reference Number:
If you included a reference number on your form, enter it here so we can more easily identify your package.
Postmarked Date:*

MonthDayYear
Approximate Date
Comments:
Should be Empty: