$500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted Crate Powertrain System Offer Valid: 01/01/2018 - 12/31/2018 Mail to: Connect & Cruise Powertrain Rebate Offer Number 66040 PO Box 6970 Mesa, AZ 85216 All of the applicable 8 digit GM Part Numbers must be purchased on the same Invoice/Repair Order and must match what is checked on this form. Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order. Customer Information Section *Denotes Required Field *First Name *Last Name *Address *City *State *Zip Code Email Phone *Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number ZZ427/480 w/ 4L70E Transmission $500 Rebate 19331572 19332781 19368613 19299801 19332775 454 HO w/ 4L85E Transmission $500 Rebate 12568774 19332784 19300175 19299804 19332780 ZZ454/440 w/ 4L85E Transmission $500 Rebate 19331574 19332784 19300175 19299804 HT502 w/ 4L85E Transmission $500 Rebate 88890534 19332784 19300175 19299804 19332780 Ram Jet 502 w/ 4L85E Transmission $500 Rebate 12499121 19332784 19300175 19299804 19332780 502 HO w/ 4L85E Transmission $500 Rebate 12568778 19332784 19300175 19299804 19332780 ZZ502/502 Deluxe w/ 4L85E Transmission $500 Rebate 19331579 19332784 19300175 19299805 19332780 ZZ572/620 Deluxe w/ 4L85E Transmission $750 Rebate 19331583 19332784 19300175 19299805 19332780 ZZ572/720R Deluxe w/ 4L85E Transmission $750 Rebate 19331585 19332784 19300175 19299805 19332780 Big Block 350/290 Deluxe w/ 4L65E Transmission $500 Rebate 19355659 19332781 19368611 19299800 19332775 350 HO Turn-Key w/ 4L65E Transmission $500 Rebate 19355662 19332781 19368611 19299800 19332775 Ram Jet 350 w/ 4L65E Transmission $500 Rebate 19355815 19332781 19368611 19299800 19332775 HT 383 w/ 4L70E Transmission $500 Rebate 19355720 19332781 19368613 19299800 19332775 SP350/385 Base w/ 4L65E Transmission $500 Rebate 19333157 19332781 19368611 19299801 19332775 SP350/357 Turn-Key w/ 4L65E Transmission $500 Rebate 19367084 19332781 19368611 19299801 19332775 SP350/385 Turn-Key w/ 4L65E Transmission $500 Rebate 19333158 19332781 19368611 19299801 19332775 SP383 Deluxe w/ 4L70E Transmission$500 Rebate 19355722 19332781 19368613 19299801 19332775 ZZ6 Base w/ 4L65E Transmission $500 Rebate 19351532 19332781 19368611 19299801 19332775 ZZ6 Turn-Key w/ 4L65E Transmission $500 Rebate 19351533 19332781 19368611 19299801 19332775 Small Block LS 376/515 w/ 4L70E Transmission $500 Rebate 19301359 19259117 19368613 19299803 19332775 LS (!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies. Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer or Authorized Reseller located in the United States and U.S. territories. In order to receive the mail-in rebate debit card, qualifying purchases must satisfy the rebate requirements as outlined on this rebate application. Failure to meet the mail-in rebate requirements will disqualify your rebate. This offer is available to retail customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. Fleet and commercial customers and GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with other General Motors offers. Limit one (1) rebate per service performed per service date and vehicle and cannot be assigned or transferred. This offer is void where taxed, restricted or prohibited by law. General Motors and their partners are not responsible for lost, late, damaged, illegible, misdirected or postage-due submissions. Any excessive submissions, misrepresentation or fraudulent information disqualifies the rebate and may give rise to criminal or civil prosecution. All rebates shall be governed by applicable state and federal laws. All terms, conditions and rules of this program are subject to change. All submitted materials become property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Card is issued by MetaBank ® , Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 12 months; unused funds will be forfeited at midnight EST the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. Please allow up to 8 weeks for delivery of the rebate. To check the status of your rebate visit "Status Lookup" at www.mycertifiedservicerebates.com or call 844.656.5369 weekdays, 7 am to 11 pm Eastern Time. Please allow up to 8 weeks for rebate processing. To receive your Visa prepaid card by mail follow these conditions of acceptance: 1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2018 and December 31, 2018. 2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of the GM Dealer Invoice/Repair Order. The invoice must have the Dealer and eligible part purchases circled. 3) Submit your rebate on-line for faster processing or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.mycertifiedservicerebates.com and follow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, along with a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by January 31, 2019. 4) By providing your contact information below, you consent that GM and/or a GM dealer can contact me with any GM offers and GM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy or call 1-866-MYPRIVACY (1-866-697-7482). Revision #2
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Small Block LS 376/515 w/ 4L70E Transmission$500 Rebate 19301359 19259117 19368613 19299803 19332775
LS
(!) IMPORTANT: Photocopy your entire submission for your records. Youmay be required to mail or fax these photocopies.
Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer or Authorized Reseller located in the United States and U.S. territories. In order to receive the mail-in rebate debit card, qualifying purchases must satisfy the rebate requirements as outlined on this rebate application. Failure to meet the mail-in rebate requirements will disqualify your rebate. This offer is available to retail customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. Fleet and commercial customers and GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with other General Motors offers. Limit one (1) rebate per service performed per service date and vehicle and cannot be assigned or transferred. This offer is void where taxed, restricted or prohibited by law. General Motors and their partners are not responsible for lost, late, damaged, illegible, misdirected or postage-due submissions. Any excessive submissions, misrepresentation or fraudulent information disqualifies the rebate and may give rise to criminal or civil prosecution. All rebates shall be governed by applicable state and federal laws. All terms, conditions and rules of this program are subject to change. All submitted materials become property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Card is issued by MetaBank®, Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 12 months; unused funds will be forfeited at midnight EST the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. Please allow up to 8 weeks for delivery of the rebate.
To check the status of your rebate visit "Status Lookup" at www.mycertifiedservicerebates.com or call 844.656.5369 weekdays, 7 am to 11 pm Eastern Time. Please allow up to 8 weeks for rebate processing.
To receive your Visa prepaid card by mail follow these conditions of acceptance:
1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2018 and December 31, 2018.2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of the GM Dealer Invoice/Repair Order. The
invoice must have the Dealer and eligible part purchases circled.3) Submit your rebate on-line for faster processing or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to
www.mycertifiedservicerebates.com and follow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit viamail: Mail this form, along with a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by January 31, 2019.
4) By providing your contact information below, you consent that GM and/or a GM dealer can contact me with any GM offers and GM productinformation. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy or call 1-866-MYPRIVACY(1-866-697-7482).
Revision #2
*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number
Mail to: Connect & Cruise Powertrain RebateOffer Number 66040
PO Box 6970
Mesa, AZ 85216
(!) IMPORTANT: Photocopy your entire submission for your records. Youmay be required to mail or fax these photocopies.
Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer or Authorized Reseller located in the United States and U.S. territories. In order to receive the mail-in rebate debit card, qualifying purchases must satisfy the rebate requirements as outlined on this rebate application. Failure to meet the mail-in rebate requirements will disqualify your rebate. This offer is available to retail customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. Fleet and commercial customers and GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with other General Motors offers. Limit one (1) rebate per service performed per service date and vehicle and cannot be assigned or transferred. This offer is void where taxed, restricted or prohibited by law. General Motors and their partners are not responsible for lost, late, damaged, illegible, misdirected or postage-due submissions. Any excessive submissions, misrepresentation or fraudulent information disqualifies the rebate and may give rise to criminal or civil prosecution. All rebates shall be governed by applicable state and federal laws. All terms, conditions and rules of this program are subject to change. All submitted materials become property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Card is issued by MetaBank®, Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 12 months; unused funds will be forfeited at midnight EST the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. Please allow up to 8 weeks for delivery of the rebate.
Revision #2
To check the status of your rebate visit "Status Lookup" at www.mycertifiedservicerebates.com or call 844.656.5369 weekdays, 7 am to 11 pm Eastern Time. Please allow up to 8 weeks for rebate processing.
To receive your Visa prepaid card by mail follow these conditions of acceptance:
1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2018 and December 31, 2018.2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of the GM Dealer Invoice/Repair Order. The
invoice must have the Dealer and eligible part purchases circled.3) Submit your rebate on-line for faster processing or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to
www.mycertifiedservicerebates.com and follow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, along with a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by January 31, 2019.
4) By providing your contact information below, you consent that GM and/or a GM dealer can contact me with any GM offers and GM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy or call 1-866-MYPRIVACY (1-866-697-7482).
*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number
To receive your Visa prepaid card by mail follow these conditions of acceptance:
Mail to: Connect & Cruise Powertrain RebateOffer Number 66040PO Box 6970Mesa, AZ 85216
1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2018 and December 31, 2018.2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of the GM Dealer Invoice/Repair Order. The
invoice must have the Dealer and eligible part purchases circled.3) Submit your rebate on-line for faster processing or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to
www.mycertifiedservicerebates.com and follow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, along with a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by January 31, 2019.
4) By providing your contact information below, you consent that GM and/or a GM dealer can contact me with any GM offers and GM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy or call 1-866-MYPRIVACY (1-866-697-7482).
(!) IMPORTANT: Photocopy your entire submission for your records. Youmay be required to mail or fax these photocopies.
Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer or Authorized Reseller located in the United States and U.S. territories. In order to receive the mail-in rebate debit card, qualifying purchases must satisfy the rebate requirements as outlined on this rebate application. Failure to meet the mail-in rebate requirements will disqualify your rebate. This offer is available to retail customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. Fleet and commercial customers and GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with other General Motors offers. Limit one (1) rebate per service performed per service date and vehicle and cannot be assigned or transferred. This offer is void where taxed, restricted or prohibited by law. General Motors and their partners are not responsible for lost, late, damaged, illegible, misdirected or postage-due submissions. Any excessive submissions, misrepresentation or fraudulent information disqualifies the rebate and may give rise to criminal or civil prosecution. All rebates shall be governed by applicable state and federal laws. All terms, conditions and rules of this program are subject to change. All submitted materials become property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Card is issued by MetaBank®, Member FDIC, pursuant to a license from Visa U.S.A. Inc. No cash access or recurring payments. Can be used everywhere Visa debit cards are accepted. Card valid for up to 12 months; unused funds will be forfeited at midnight EST the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. Please allow up to 8 weeks for delivery of the rebate.
Revision #2
To check the status of your rebate visit "Status Lookup" at www.mycertifiedservicerebates.com or call 844.656.5369 weekdays, 7 am to 11 pm Eastern Time. Please allow up to 8 weeks for rebate processing.