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$500/$750 GM Visa Prepaid Card Connect & Cruise Rebate · PDF file$500/$750 GM Visa® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted Crate Powertrain System Offer

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  • $500/$750 GM Visa Prepaid Card Connect & Cruise Rebate OfferAutomatic Carbureted Crate Powertrain System Offer Valid: 01/01/2018 - 12/31/2018

    Mail to: Connect & Cruise Powertrain RebateOffer 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. 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

    $500/$750 GM Visa Prepaid Card Connect & Cruise Rebate OfferAutomatic Fuel-Injected Crate Powertrain System Offer Valid: 01/01/2018 - 12/31/2018

    Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order.

    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.

    Customer Information Section *Denotes Required Field*First Name *Last Name

    *Address

    *City *State *Zip Code

    Email Phone

    L96 (6.0L) 2WD w/ 4L65E Transmission$500 Rebate 12677741 19368611 19356410 19299802 19259117

    L96 (6.0L) 4WD w/ 4L65E Transmission$500 Rebate 12677741 19368612 19356410 19299802

    19302405

    19302405 19259117

    LS7 (7.0L) w/ 4L70E Transmission$750 Rebate 19299802 or 19299803 19329246 19354334 19259117 19368613 19302405

    LS7 (7.0L) w/ 4L75E Transmission$750 Rebate 19299802 or 19299803 19329246 19354334 19259117 19368615 19302405

    LS376/480 w/ 4L70E Transmission$500 Rebate 19301358 19299803 19354330 19302405 19259117 19368613

    LS/LT LS3 (6.2L) 2WD w/ 4L65E Transmission$500 Rebate 19301326 19299802 19354328 19302405 19259117 19368611

    LS3 (6.2L) 4WD w/ 4L70E 4WD Transmission$500 Rebate 19301326 19299802 19354328 19302405 19259117 19368612

    LS3 (6.2L) E-ROD w/ 4L65E Transmission$500 Rebate 19257230 19299802 19259117 19302405 19368611

    LS376/525 w/ 4L70E Transmission$500 Rebate 19301360 19299803 19354332 19302405 19259117 19368613

    LS376/525 w/ 4L75E Transmission$750 Rebate 19301360 19354332 19259117 19368615 19299803 19302405

    LT1 (6.2L) Dry Sump w/ 4L70E Transmission$500 Rebate 19329997 19299802 19368831 19302405 19329416 19368614

    LT1 (6.2L) Wet Sump w/ 4L70E Transmission$500 Rebate 19355405 19299802 19368833 19302405 19368614 19329416

    LT1 (6.2L) E-ROD Wet Sump w/ 4L70E Transmission$500 Rebate 12682080 19302405 19368614 19329416 19299802

    LT1 (6.2L) w/ 8L90E Transmission$500 Rebate 19355405 19367134 19368835 24283284 LT376/535 w/ 4L75E Transmission$500 Rebate 19355378 19299803 19368837 19302405 19329416 19368615

    LSA (6.2L) E-ROD w/ 4L75E Transmission$750 Rebate 19257456 19368615 19299802 19302405 19259117

    LSA (6.2L) NON E-ROD w/ 4L85E Transmission$750 Rebate 19331507 19300175

    19299806

    1930241019259119

    LT4 (6.2L) Dry Sump w/ 4L75E Transmission$500 Rebate 19332702 19368615 19368843 19299802 19329416 19302405

    LT4 (6.2L) Wet Sump w/ 4L75E Transmission$500 Rebate 19368622 19368615 19368843 19299802 19329416 19302405

    LT4 (6.2L) Wet Sump w/ 8L90E Transmission $500 Rebate 19368622 19367135 19368845 24284144

    LSA (6.2L) E-ROD w/ 4L85E Transmission$750 Rebate 19257456 19300175 19259119 19299806 19302410

    LSA (6.2L) NON E-ROD w/ 4L75E Transmission$750 Rebate 19331507 19354336 19368615 19299802 19302405 19259117

    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

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