2016 Connect & Cruise Crate Powertrain Consumer Rebate

Automatic Crate Powertrain System Program Dates: 01/01/2016 - 12/31/2016 Connect & Cruise Crate Powertrain Consumer Rebate GM Certiﬁed Services Visa® Prepaid Card Offer

To receive your Visa prepaid card by mail follow these conditions of acceptance: 1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2016 and December 31, 2016. Rebate limited to two per household. Mail to: 2) Complete all information requested on this form accurately and legibly. Connect & Cruise Powertrain 3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identiﬁcation Rebate and circle the purchase(s). Offer Number 66013 4) Mail a copy of your Invoice/Repair Order and this completed rebate form to the address below. Submission must be postmarked by January 31, 2017. PO Box 6970 Mesa, AZ 85216 5) To check the status of your submission, visit the “My Rebate Status” section at www.mycertiﬁedservicerebates.com.

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies. Customer Information Section *Denotes Required Field *First Name *Last Name

*Address

*City *State *Zip Code

Email Phone

Please check here if you would like to receive the Chevrolet Performance Fuel Newsletter. To read the GM Privacy Statement, go to www.gm.com/privacy.

*Dealership/Retailer Location *Dealer/Retailer Zip Code *Date of Service (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. LC9 (5.3L) LS3 (6.2L) LT1 (6.2L) LSA (6.2L) 2WD E-ROD - $500 Rebate 2WD - $500 Rebate Dry Sump - $500 Rebate E-ROD - $750 Rebate 19258004 19299802 19301326 19299802 19329997 19299802 19257456 19300175 19260380 19302405 19258270 19259117 19303137 19302405 19302410 19299806 19259117 19260380 19302405 19329645 19329416 19259119 4WD E-ROD - $500 Rebate 4WD - $500 Rebate Wet Sump - $500 Rebate NON E-ROD - $750 Rebate 19258004 19299802 192301326 19299802 19328728 19299802 19331507 19302410 19260961 19302405 19258270 19259117 19303137 19302405 19259293 19259119 19259117 19260961 19302405 19329645 19329416 19300175 19299806 LS376/480 E-ROD - $500 Rebate LS376/525 LS7(7.0L) $500 Rebate 19257230 19299802 $500 Rebate $750 Rebate 19301358 19299803 19260380 19302405 19301360 19299803 19244098 19258553 19258267 19302405 19259117 19259261 19302405 19299055 19302405 19259117 19299055 19299055 19259117 19259117 19299802 or 19299803

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.

If you have not received your prepaid card within 8 weeks after the postmark date of your qualified submission, or if you have questions about your submission, call (844) 656-5369 weekdays, 7am to 11pm EST. Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, Buick, GMC, Cadillac dealer or a Powertrain retailer located in the United States. Your right to receive this rebate will not be earned unless you satisfy the rebate requirements as outlined on this rebate application. Failure to comply with the rebate requirements will disqualify your rebate. This offer is available to all customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. This offer is for retail customers only. Fleet and commercial customers are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with any other General Motors offers, unless specified in writing by General Motors. Limit one (1) rebate per service performed per service date and vehicle. Your rights to this offer 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. Excessive submissions constitute fraud and may result in federal prosecution under the U.S. mail fraud statutes (Title 18, USC 1341 and 1342). Any 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. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD) applies, but is waived for the first twelve months after the card is issued. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Please allow up to 8 weeks for delivery of the rebate. Manual Crate Powertrain System Program Dates: 01/01/2016 - 12/31/2016 Connect & Cruise Crate Powertrain Consumer Rebate GM Certified Services Visa® Prepaid Card Offer

*Address

*City *State *Zip Code

Email Phone

Please check here if you would like to receive the Chevrolet Performance Fuel Newsletter. To read the GM Privacy Statement, go to www.gm.com/privacy.

*Dealership/Retailer Location *Dealer/Retailer Zip Code *Date of Service (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. Small Block LS/LT LS/LT LS/LT LS/LT Ram Jet 350 (5.7L) LC9 (5.3L)- E-ROD LS376/480 LSA (6.2L) - NON E-ROD LS7(7.0L) $500 Rebate $500 Rebate $500 Rebate $750 Rebate $750 Rebate 12499120 19258004 19301358 19331507 19244098 19329900 19301625 19258267 19259293 19258553 19329795 19329795 19301625 19329912 19301625 19329795 19329795 19329795 SP383 LS3 (6.2L) $500 Rebate $500 Rebate LS376/515 LSA (6.2L) - E-ROD LT1 (6.2L) - Wet 19332532 19301326 $500 Rebate $750 Rebate $500 Rebate 19329900 19258270 19301359 19257456 19328728 19329795 19301625 19301625 19329912 19303137 19329795 19329795 19329795 19329912 SP350 T/K 19329795 $500 Rebate LS3 (6.2L) - E-ROD LS376/525 LS9 (6.2L) 19333158 $500 Rebate $500 Rebate $2000 Rebate LT1 (6.2L) - Dry 19329900 19257230 19301360 19260165 $500 Rebate 19329795 19301625 19259261 19299462 19329997 19329795 19301625 19329795 19303137 19329795 19331083 19329912 19329795 Big Block ZZ427/480 427 Anniversary ZZ454/440 ZZ502 Ram Jet 502 ZZ572/620 Deluxe $500 Rebate $750 Rebate $500 Rebate $500 Rebate $500 Rebate $750 Rebate 19331572 19166392 19331574 19331579 12499121 19331583 19329902 19329902 19329901 19329901 19329901 19329902 19329795 19329795 19329795 19329795 19329795 19329795 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. If you have not received your prepaid card within 8 weeks after the postmark date of your qualified submission, or if you have questions about your submission, call (844) 656-5369 weekdays, 7am to 11pm EST. Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, Buick, GMC, Cadillac dealer or a Powertrain retailer located in the United States. Your right to receive this rebate will not be earned unless you satisfy the rebate requirements as outlined on this rebate application. Failure to comply with the rebate requirements will disqualify your rebate. This offer is available to all customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. This offer is for retail customers only. Fleet and commercial customers are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with any other General Motors offers, unless specified in writing by General Motors. Limit one (1) rebate per service performed per service date and vehicle. Your rights to this offer 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. Excessive submissions constitute fraud and may result in federal prosecution under the U.S. mail fraud statutes (Title 18, USC 1341 and 1342). Any 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. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USD) applies, but is waived for the first twelve months after the card is issued. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. Please allow up to 8 weeks for delivery of the rebate.