4
Customer Information Section *Denotes Required Field $500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted Crate Powertrain System Offer Valid: 11/01/2019 - 10/31/2020 To receive your Visa prepaid card by mail follow these conditions of acceptance: 1) Purchase a Chevrolet Performance Crate Powertrain system between November 1, 2019 and October 31, 2020. 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 or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.gmpartsrebates.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 November 30, 2020. 4) By providing your contact information below you consent that GM and/or a GM dealer may contact you 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. Mail to: Connect & Cruise Powertrain Rebate Offer Number 2019080 P.O. Box 341835, Bartlett, TN 38134 To check the status of your rebate visit at www.gmpartsrebates.com or call (866) 713-7284 weekdays, 7 am to 7 pm Central Time. Please allow up to 8 weeks for rebate processing 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 6 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. Please allow up to 8 weeks for delivery of the rebate. Unless specifically noted to the contrary herein, vehicles equipped with Chevrolet Performance Parts that are emissions related may not meet U.S., Canadian, and state and provincial laws and regulations relating to motor vehicle emissions. These parts are designed and intended for use in vehicles operated exclusively for competition: in racing or organized competition on courses separate from public streets or highways. For more information, please see Page 2 of the Chevrolet Performance Catalog. WARNING: These auto parts can expose you to chemicals including phthalates and lead. Installing or using these parts can expose you to other parts containing these chemicals and to engine exhaust, which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov. Small-Block LS Big-Block o 350/290 Deluxe w/ 4L65E Transmission $500 Rebate o 19355659 o 19332781 o 19368611 o 19299800 o 19332775 o 350 HO Turn-Key w/ 4L65E Transmission $500 Rebate o 19210009 o 19332781 o 19368611 o 19299800 o 19332775 o Ram Jet 350 w/ 4L65E Transmission $750 Rebate o 19417619 o 19332781 o 19332775 o 19299800 o 19368611 o HT383 w/ 4L70E Transmission $500 Rebate o 19355720 o 19332781 o 19332775 o 19299800 o 19368613 o SP350/385 Base w/ 4L65E Transmission $500 Rebate o 19417624 o 19332781 o 19368611 o 19299801 o 19332775 o LS376/515 w/ 4L70E Transmission $500 Rebate o 19370412 o 19299803 o 19259117 o 19332775 o 19368613 o SP350/357 Turn-Key w/ 4L65E Transmission $500 Rebate o 19418190 o 19332781 o 19368611 o 19299801 o 19332775 o SP350/385 Turn-Key w/ 4L65E Transmission $500 Rebate o 19418137 o 19332781 o 19368611 o 19299801 o 19332775 o SP383 Deluxe w/ 4L70E Transmission $500 Rebate o 19355772 o 19332781 o 19332775 o 19299801 o 19368613 o ZZ6 Base w/ 4L65E Transmission $500 Rebate o 19417576 o 19332781 o 19368611 o 19299801 o 19332775 o ZZ6 Turn-Key w/ 4L65E Transmission $500 Rebate o 19418136 o 19332781 o 19368611 o 19299801 o 19332775 o ZZ427/480 w/ 4L70E Transmission $500 Rebate o 19331572 o 19332780 o 19332781 o 19299801 o 19368613 o 454 HO w/ 4L85E Transmission $500 Rebate o 12568774 o 19332784 o 19300175 o 19299804 o 19332780 o ZZ454/440 w/ 4L85E Transmission $500 Rebate o 19331574 o 19332784 o 19300175 o 19299804 o 19332780 o HT502 w/ 4L85E Transmission $500 Rebate o 88890534 o 19332784 o 19300175 o 19299804 o 19332780 o 502 HO w/ 4L85E Transmission $500 Rebate o 12568778 o 19332784 o 19300175 o 19299804 o 19332780 o ZZ502/502 Deluxe w/ 4L85E Transmission $500 Rebate o 19331579 o 19332784 o 19300175 o 19299805 o 19332780 o ZZ572/620 Deluxe w/ 4L85E Transmission $750 Rebate o 19331583 o 19332784 o 19300175 o 19299805 o 19332780 o ZZ572/720R Deluxe w/ 4L85E Transmission $750 Rebate o 19331585 o 19332784 o 19300175 o 19299805 o 19332780 o LS376/515 w/ 4L70E Transmission $500 Rebate o 19370412 o 19299803 o 19259117 o 19332775 o 19368613 *First Name *Last Name *Address *City *State *Zip Code Email Phone (!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies. *Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order.

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Page 1: Customer Information Section enotes euired ied...Customer Information Section enotes euired ied $500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted

Customer Information Section *Denotes Required Field

$500/$750 GM Visa® Prepaid Card Connect & Cruise Rebate OfferAutomatic Carbureted Crate Powertrain SystemOffer Valid: 11/01/2019 - 10/31/2020

To receive your Visa prepaid card by mail follow these conditions of acceptance:

1) Purchase a Chevrolet Performance Crate Powertrain system between November 1, 2019 and October 31, 2020.

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 or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.gmpartsrebates.com andfollow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, alongwith a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by November 30, 2020.

4) By providing your contact information below you consent that GM and/or a GM dealer may contact you with any GM offers andGM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy.

Mail to: Connect & Cruise Powertrain RebateOffer Number 2019080P.O. Box 341835, Bartlett, TN 38134

To check the status of your rebate visit at www.gmpartsrebates.com orcall (866) 713-7284 weekdays, 7 am to 7 pm Central Time. Please allow up to 8 weeks for rebate processing

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 6 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. Please allow up to 8 weeks for delivery of the rebate. Unless specifically noted to the contrary herein, vehicles equipped with Chevrolet Performance Parts that are emissions related may not meet U.S., Canadian, and state and provincial laws and regulations relating to motor vehicle emissions. These parts are designed and intended for use in vehicles operated exclusively for competition: in racing or organized competition on courses separate from public streets or highways. For more information, please see Page 2 of the Chevrolet Performance Catalog.

� WARNING: These auto parts can expose you to chemicals including phthalates and lead. Installing or using these parts can expose you to other parts containing these chemicals and to engine exhaust, which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.

Small-Block LS Big-Block

o 350/290 Deluxe w/ 4L65E Transmission $500 Rebateo 19355659 o 19332781o 19368611 o 19299800o 19332775

o 350 HO Turn-Key w/ 4L65ETransmission $500 Rebateo 19210009 o 19332781o 19368611 o 19299800o 19332775

o Ram Jet 350 w/ 4L65E Transmission $750 Rebateo 19417619 o 19332781o 19332775 o 19299800o 19368611

o HT383 w/ 4L70E Transmission$500 Rebateo 19355720 o 19332781o 19332775 o 19299800o 19368613

o SP350/385 Base w/ 4L65E Transmission $500 Rebateo 19417624 o 19332781o 19368611 o 19299801o 19332775

o LS376/515 w/ 4L70E Transmission $500 Rebateo 19370412 o 19299803o 19259117 o 19332775o 19368613

o SP350/357 Turn-Key w/ 4L65E Transmission $500 Rebateo 19418190 o 19332781o 19368611 o 19299801o 19332775

o SP350/385 Turn-Key w/ 4L65E Transmission $500 Rebateo 19418137 o 19332781o 19368611 o 19299801o 19332775

o SP383 Deluxe w/ 4L70E Transmission $500 Rebateo 19355772 o 19332781o 19332775 o 19299801o 19368613

o ZZ6 Base w/ 4L65E Transmission$500 Rebateo 19417576 o 19332781o 19368611 o 19299801o 19332775

o ZZ6 Turn-Key w/ 4L65E Transmission $500 Rebateo 19418136 o 19332781o 19368611 o 19299801o 19332775

o ZZ427/480 w/ 4L70E Transmission$500 Rebateo 19331572 o 19332780o 19332781 o 19299801o 19368613

o 454 HO w/ 4L85E Transmission$500 Rebateo 12568774 o 19332784o 19300175 o 19299804o 19332780

o ZZ454/440 w/ 4L85E Transmission$500 Rebateo 19331574 o 19332784o 19300175 o 19299804o 19332780

o HT502 w/ 4L85E Transmission$500 Rebateo 88890534 o 19332784o 19300175 o 19299804o 19332780

o 502 HO w/ 4L85E Transmission$500 Rebateo 12568778 o 19332784o 19300175 o 19299804o 19332780

o ZZ502/502 Deluxe w/ 4L85E Transmission $500 Rebateo 19331579 o 19332784o 19300175 o 19299805o 19332780

o ZZ572/620 Deluxe w/ 4L85E Transmission $750 Rebateo 19331583 o 19332784o 19300175 o 19299805o 19332780

o ZZ572/720R Deluxe w/ 4L85E Transmission $750 Rebateo 19331585 o 19332784o 19300175 o 19299805o 19332780

o LS376/515 w/ 4L70E Transmission $500 Rebateo 19370412 o 19299803o 19259117 o 19332775o 19368613

*First Name *Last Name

*Address

*City *State *Zip Code

Email Phone

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number

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

Page 2: Customer Information Section enotes euired ied...Customer Information Section enotes euired ied $500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted

Customer Information Section *Denotes Required Field

$500/$750 GM Visa® Prepaid Card Connect & Cruise Rebate OfferAutomatic Fuel-Injected Crate Powertrain SystemOffer Valid: 11/01/2019 - 10/31/2020

To receive your Visa prepaid card by mail follow these conditions of acceptance:

1) Purchase a Chevrolet Performance Crate Powertrain system between November 1, 2019 and October 31, 2020.

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 or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.gmpartsrebates.com andfollow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, alongwith a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by November 30, 2020.

4) By providing your contact information below you consent that GM and/or a GM dealer may contact you with any GM offers andGM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy.

Mail to: Connect & Cruise Powertrain RebateOffer Number 2019080P.O. Box 341835, Bartlett, TN 38134

To check the status of your rebate visit at www.gmpartsrebates.com orcall (866) 713-7284 weekdays, 7 am to 7 pm Central Time. Please allow up to 8 weeks for rebate processing

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 6 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. Please allow up to 8 weeks for delivery of the rebate. Unless specifically noted to the contrary herein, vehicles equipped with Chevrolet Performance Parts that are emissions related may not meet U.S., Canadian, and state and provincial laws and regulations relating to motor vehicle emissions. These parts are designed and intended for use in vehicles operated exclusively for competition: in racing or organized competition on courses separate from public streets or highways. For more information, please see Page 2 of the Chevrolet Performance Catalog.

� WARNING: These auto parts can expose you to chemicals including phthalates and lead. Installing or using these parts can expose you to other parts containing these chemicals and to engine exhaust, which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.

*First Name *Last Name

*Address

*City *State *Zip Code

Email Phone

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number

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

LS/LT

o L96 (6.0L) 2WD w/ 4L65E Transmission$500 Rebateo 19416591 o 19368611o 19418490 o 19299802o 19259117 o 19302405

o L96 (6.0L) 4WD w/ 4L70E Transmission$500 Rebateo 19416591 o 19368612o 19418490 o 19299802o 19259117 o 19302405

o L96 (6.0L) w/ 6L80E Transmission$500 Rebateo 19416591 o 19366637o 19418490 o 19367014

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

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

o 19329246 o 19354334

o 19329246 o 19354334

o 19370411 o 19354330 o 19259117

o 19370416 o 19354328 o 19259117

o 19370416 o 19354328

o LS7 (7.0L) w/ 6L80E (2400k) Transmission$750 Rebate

o 19366637o 19367014

o LS7 (7.0L) w/ 6L80E (3000k) Transmission$750 Rebate

o 19417102o 19367014

o LS376/480 w/ 4L70E Transmission$500 Rebate

o 19299803o 19302405o 19368613

o LS3 (6.2L) 2WD w/ 4L65E Transmission$500 Rebate

o 19299802o 19302405o 19368611

o LS3 (6.2L) 4WD w/ 4L70E 4WD Transmission $500 Rebate

o 19299802o 19302405

o 19259117o 19368612

o 19370414 o 19259117

o 19370416 o 19354328

o 19370414

o 19368613 o 19370413 o 19354332

o 19370413 o 19354332 o 19259117

o LS3 (6.2L) E-ROD w/ 4L65E Transmission$500 Rebate

o 19299802o 19302405

o 19368611

o LS3 (6.2L) w/ 6L80E Transmission$500 Rebate

o 19366637o 19367014

o LS3 (6.2L) E-ROD w/ 6L80E Transmission$500 Rebate

o 19367014o 19366637

o LS376/525 w/ 4L70E Transmission$500 Rebate

o 19299803o 19302405o 19259117

o LS376/525 w/ 4L75E Transmission$750 Rebate

o 19368615o 19302405o 19299803

o LS376/480 (6.2L) w/ 6L80E Transmission$500 Rebateo 19370411 o 19417102o 19354330 o 19367014

o LS376/525 (6.2L) w/ 6L80E Transmission$500 Rebateo 19370413 o 19417102o 19354332 o 19367014

o LSA (6.2L) w/ 6L80E Transmission$750 Rebateo 19370850 o 19366637o 19369381 o 19367014

o LSA (6.2L) w/ 4L75E Transmission$750 Rebateo 19370850 o 19368615o 19369381 o 19299802o 19302410 o 19259117

o LSA (6.2L) E-ROD w/ 4L75E Transmission$750 Rebateo 19416892 o 19368615o 19299802 o 19302405o 19259117

Page 3: Customer Information Section enotes euired ied...Customer Information Section enotes euired ied $500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted

Customer Information Section *Denotes Required Field

$500/$750 GM Visa® Prepaid Card Connect & Cruise Rebate OfferAutomatic Fuel-Injected Crate Powertrain SystemOffer Valid: 11/01/2019 - 10/31/2020

To receive your Visa prepaid card by mail follow these conditions of acceptance:

1) Purchase a Chevrolet Performance Crate Powertrain system between November 1, 2019 and October 31, 2020.

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 or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.gmpartsrebates.com andfollow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, alongwith a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by November 30, 2020.

4) By providing your contact information below you consent that GM and/or a GM dealer may contact you with any GM offers andGM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy.

Mail to: Connect & Cruise Powertrain RebateOffer Number 2019080P.O. Box 341835, Bartlett, TN 38134

To check the status of your rebate visit at www.gmpartsrebates.com orcall (866) 713-7284 weekdays, 7 am to 7 pm Central Time. Please allow up to 8 weeks for rebate processing

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 6 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. Please allow up to 8 weeks for delivery of the rebate. Unless specifically noted to the contrary herein, vehicles equipped with Chevrolet Performance Parts that are emissions related may not meet U.S., Canadian, and state and provincial laws and regulations relating to motor vehicle emissions. These parts are designed and intended for use in vehicles operated exclusively for competition: in racing or organized competition on courses separate from public streets or highways. For more information, please see Page 2 of the Chevrolet Performance Catalog.

� WARNING: These auto parts can expose you to chemicals including phthalates and lead. Installing or using these parts can expose you to other parts containing these chemicals and to engine exhaust, which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.

*First Name *Last Name

*Address

*City *State *Zip Code

Email Phone

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number

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

LS/LT (continued) Small-Block

o LSA (6.2L) w/ 4L85E Transmission$750 Rebateo 19300175 o 19370850o 19299806 o 19369381o 19259119 o 19302410

o LSA (6.2L) E-ROD w/ 4L85E Transmission$750 Rebateo 19416892 o 19300175o 19259119 o 19299806o 19302410

o LT1 (6.2L) Dry Sump w/ 4L70E Transmission $500 Rebateo 19329997 o 19299802o 19417227 o 19302405o 19329416 o 19368614

o LT1 (6.2L) Wet Sump w/ 4L70E Transmission $500 Rebateo 19418843 o 19299802o 19417228 o 19302405o 19368614 o 19329416

o LT1(6.2L) E-ROD Wet Sump w/ 4L70E Transmission $500 Rebateo 19370671 o 19302405o 19368614 o 19329416o 19299802

o LT1 (6.2L) Wet Sump w/ 8L90E Transmission $500 Rebateo 19418843 o 19417103o 19417229 o 19417579

o LT1 (6.2L) Wet Sump E-ROD w/ 8L90E Transmission $500 Rebateo 19417593 o 19417579o 19417103

o LT376/535 w/ 4L75E Transmission$750 Rebateo 19355378 o 19299803o 19417230 o 19302405o 19368615 o 19329416o 19125817

o LT4 (6.2L) Dry Sump w/ 4L75E Transmission $750 Rebateo 19416595 o 19368615o 19419241 o 19299802o 19329416 o 19302405o 19125817

o LT4 (6.2L) Wet Sump w/ 4L75E Transmission $750 Rebateo 19418844 o 19299802o 19419241 o 19302405o 19329416 o 19125817o 19368615

o LT4 (6.2L) E-ROD Wet Sump w/ 4L75E Transmission $750 Rebateo 19356048 o 19299802o 19329416 o 19302405o 19368615 o 19125817

o LT4 (6.2L) Wet Sump w/ 8L90E Transmission $750 Rebateo 19418844 o 19417103o 19419242 o 19417580

o LT4 (6.2L) E-ROD Wet Sump w/ 8L90E Transmission $750 Rebateo 19417727 o 19417580o 19417103

o LT5 (6.2L) Dry Sump w/ 8L90E Transmission $750 Rebateo 19417105 o 19418254o 19418244 o 19418408o 19417103

o ZZ6 EFI Deluxe w/ 4L65E Transmission$500 Rebateo 19368149 o 19332781o 19368611 o 19299801o 19332775 o 19419371

o ZZ6 EFI Turn-Key w/ 4L65E Transmission$500 Rebateo 19368150 o 19299801o 19332781 o 19332775o 19368611 o 19419371

o SP383 EFI Turn-Key w/ 4L70E Transmission $500 Rebateo 19419199 o 19299800o 19332781 o 19332775o 19368613 o 19419371

o SP383 EFI Deluxe w/ 4L70E Transmission$500 Rebateo 19418640 o 19299800o 19332781 o 19332775o 19368613 o 19419371

Page 4: Customer Information Section enotes euired ied...Customer Information Section enotes euired ied $500/$750 GM Visa ® Prepaid Card Connect & Cruise Rebate Offer Automatic Carbureted

Customer Information Section *Denotes Required Field

$500/$750 GM Visa® Prepaid Card Connect & Cruise Rebate OfferManual Powertrain SystemOffer Valid: 11/01/2019 - 10/31/2020

To receive your Visa prepaid card by mail follow these conditions of acceptance:

1) Purchase a Chevrolet Performance Crate Powertrain system between November 1, 2019 and October 31, 2020.

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 or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.gmpartsrebates.com andfollow the instructions. You will be required to upload a copy of your Invoice/Repair Order. To submit via mail: Mail this form, alongwith a copy of your GM Dealer Invoice, to the address below. Submission must be postmarked by November 30, 2020.

4) By providing your contact information below you consent that GM and/or a GM dealer may contact you with any GM offers andGM product information. For more information on the GM Privacy Statement please visit our website http://www.gm.com/privacy.

Mail to: Connect & Cruise Powertrain RebateOffer Number 2019080P.O. Box 341835, Bartlett, TN 38134

To check the status of your rebate visit at www.gmpartsrebates.com orcall (866) 713-7284 weekdays, 7 am to 7 pm Central Time. Please allow up to 8 weeks for rebate processing

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 6 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. Please allow up to 8 weeks for delivery of the rebate. Unless specifically noted to the contrary herein, vehicles equipped with Chevrolet Performance Parts that are emissions related may not meet U.S., Canadian, and state and provincial laws and regulations relating to motor vehicle emissions. These parts are designed and intended for use in vehicles operated exclusively for competition: in racing or organized competition on courses separate from public streets or highways. For more information, please see Page 2 of the Chevrolet Performance Catalog.

� WARNING: These auto parts can expose you to chemicals including phthalates and lead. Installing or using these parts can expose you to other parts containing these chemicals and to engine exhaust, which are known to the State of California to cause cancer and birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov.

Small-Block Big-Block

LS/LT

*First Name *Last Name

*Address

*City *State *Zip Code

Email Phone

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

*Dealer/Authorized Reseller Location *Dealer/Authorized Reseller Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number

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

o Ram Jet 350 (5.7L) w/ T56 Manual Transmission $500 Rebateo 19417619 o 19352208o 19329900

o SP383 Deluxe w/ T56 Manual Transmission $500 Rebateo 19355722 o 19352208o 19329900

o SP350/357 T/K w/ T56 Manual Transmission $750 Rebateo 19418190 o 19352208o 19329900

o SP350/385 Turn-Key w/ T56 Manual Transmission $750 Rebateo 19418137 o 19352208o 19329900

o ZZ6 EFI Deluxe w/ T56 Manual Transmission $500 Rebateo 19368149 o 19329900o 19352208

o ZZ6 EFI Turn-Key w/ T56 Manual Transmission $500 Rebateo 19368150 o 19329900o 19352208

o 383 EFI Turn-Key w/ T56 Manual Transmission $500 Rebateo 19419199 o 19352208o 19329900

o 383 EFI Deluxe w/ T56 Manual Transmission $500 Rebateo 19418640 o 19352208o 19329900

o ZZ427/480 w/ T56 Manual Transmission $750 Rebateo 19331572 o 19329902o 19352208

o ZZ454/440 w/ T56 Manual Transmission $500 Rebateo 19331574 o 19329901o 19352208

o ZZ502/502 w/ T56 Manual Transmission $750 Rebateo 19331579 o 19329901o 19352208

o ZZ572/620 Deluxe w/ T56 Manual Transmission $750 Rebateo 19331583 o 19329902o 19352208

o L96 w/ T56 Manual Transmission$500 Rebateo 19416591 o 19301625o 19418490 o 19352208

o LS3 (6.2L) w/ T56 ManualTransmission $500 Rebateo 19370416 o 19301625o 19354328 o 19352208

o LS3 (6.2L) - E-ROD w/ T56 ManualTransmission $500 Rebateo 19370414 o 19352208o 19301625

o LS376/480 w/ T56 Manual Transmission $500 Rebateo 19370411 o 19301625o 19354330 o 19352208

o LS376/515 w/ T56 Manual Transmission $500 Rebateo 19370412 o 19352208o 19301625

o LS376/525 w/ T56 Manual Transmission $500 Rebateo 19370413 o 19301625o 19354332 o 19352208

o LSA (6.2L) w/ T56 Manual Transmission $750 Rebateo 19370850 o 19329912o 19369381 o 19352208

o LSA (6.2L) - E-ROD w/ T56 Manual Transmission $500 Rebateo 19416892 o 19352208o 19329912

o LT376/535 (6.2L) w/ T56 ManualTransmission $500 Rebateo 19355378 o 19352208o 19417230 o 19329416

o LS7 (7.0L) w/ T56 Manual Transmission $750 Rebateo 19329246 o 19352208o 19301625 o 19354334

o LT1 (6.2L) Wet Sump w/ T56 Manual Transmission $500 Rebateo 19416592 o 19329912o 19417228 o 19352208

o LT1 (6.2L) Dry Sump w/ T56 Manual Transmission $500 Rebateo 19329997 o 19329912o 19417227 o 19352208

o LT1 (6.2L) E-ROD Wet Sump w/ T56 Manual Transmission $750 Rebateo 19370671 o 19329416o 19352208

o LT4 (6.2L) Wet Sump w/ T56 Manual Transmission $500 Rebateo 19418844 o 19329912o 19419241 o 19352208

o LT4 (6.2L) E-ROD Wet Sump w/ T56Manual Transmission $750 Rebateo 19356048 o 19352208o 19329912

o LT4 (6.2L) Dry Sump w/ T56 Manual Transmission $500 Rebateo 19416595 o 19329912o 19419241 o 19352208

o LT5 (6.2L) Wet Sump w/ T56 Manual Transmission $750 Rebateo 19417105 o 19352208o 19418270 o 19329912