SPARTAN CHASSIS DELIVERY PREP FORM Valid from 1-1-2015 to 12-31-2015 (Revised January 2013) Submit to your Spartan Regional Manager for Review and Approval

End User: Name: Address: City: State: Zip: Contact Person: Phone: Email Address: * Vehicle Identification Number (MUST BE PROVIDED): * Delivery Date to End User (MUST BE PROVIDED): Chassis Model: Gladiator Gladiator 4x4 Metro Star Metro Star - X Other Apparatus Manufacturer: Number of Seats: Unit Type: Pumper Ladder Rescue Tanker Hazmat Other Body: Aluminum Galvanneal Stainless Steel Other Size of Water Tank: 500 750 1000 Other Manufacturer of Pump: Waterous Hale Darley Other Pump: Model: GPM: One or Two Stage: Type of Engine: Cummins Detroit Diesel Caterpillar HP: Transmission: Allison Other Model: Vehicle Weight Complete: Front: Rear: Gross: Does above weight include: Water 1st Responders Equipment None Customer Acceptance of Vehicle: (1 to 10) (10 being best)

Contact Information: (Rebates paid by information provided by W9, if registered Canadian business by company name on signed Loyalty Agreement) Salesperson: Business Name: Is This a Dealer or OEM Address: City: State: Zip: Check One: Sole Proprietorship (Copy of Business License) Corporation - Employer ID # Individual - Owner/President Approval on Loyalty Agreement – SS #

REQUIRED DOCUMENTS TO BE SENT WITH THIS FORM: 1) Spartan Warranty Registration Form, signed by Department. If done online print hard copy to submit. 2) Include a minimum of 6 digital photos of the vehicle with a camera resolution of 3 mega pixels or greater. a. All photos must arrive on a CD (write on CD shop order number, name of your company and end user) b. There must be 4 photos of the exterior (front, rear and each side) and 2 photos of the interior (driver/officer area and crew area) included in the 6 photos. Do not email photos they must be on a CD. **NOTE: All above information MUST be filled out and submitted to Spartan Regional Manager. Chassis Delivery Prep Packages will only receive a rebate for invoiced units from 2014 and 2013 (no older). If this completed document is not submitted with applicable items 1 – 2 noted above within the aforementioned time frame, the rebate for that unit WILL NOT BE PAID!! If not submitted Spartan Chassis will contact end user to complete the warranty information and the rebate will no longer be available to be submitted. Print, sign, date and submit with CD of photos (DO Not Email Photos Only Submit a CD) and warranty form – (if warranty is done online print hard copy to submit) to your Spartan Regional Manager.

Please allow 4 to 6 weeks for payment to be processed.

Sales Representative (Signature): ______DATE: ______Spartan Chassis (Signature): ______DATE: ______