CRATE POWERTRAIN SYSTEMS CONSUMER REBATE

LS3 (6.2L) Connect and Cruise System CPSLS34L65E

*Certi ed Service Visa® Prepaid Card rebate when all system parts are purchased on the same invoice from a dealer or Authorized Retailer January 1, 2014 to December 31, 2014. Rebate limited to two per household.

Power your project with the next level of crate engine convenience, assurance and value! Performance pioneered the concept of crate engines more than four decades ago, and continues to lead the industry with the exclusive Connect & Cruise Crate Powertrain Systems – factory-engineered engine-and-transmission combinations that include all the electronic control modules, wiring harnesses and other key components. Now available in 12 different combinations including emissions-certi ed E-ROD packages!

** Torque Converter 24217235 requires the purchase of a flywheel kit. See back for complete details and Connect & Cruise Crate Powertrain Claim Form. For more information on Connect & Cruise Crate Powertrain Systems, see page 198 in the 2014 Chevrolet Performance Catalog. Pricing may vary. See your Chevrolet Performance Dealer for local pricing. chevroletperformance.com Program Dates: 01/01/2014 - 12/31/2014 Connect & Cruise Crate Powertrain Consumer Rebate GM Certi ed 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, 2014 and December 31, 2014. 2) Complete all information requested on this form accurately and legibly. 3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identi cation and circle the purchase(s). 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, 2015. Mail to: Connect & Cruise Powertrain Rebate Offer # 14-79243 PO Box 540062 El Paso, TX 88554-0062 5) To check the status of your submission, visit the “My Rebate Status” section at www.mycerti edservicerebates.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

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*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.

CPSLC94L65E - $500 Rebate CPSLC9ER0D4L70E - $500 Rebate CPSL3764804L70E - $500 Rebate CPSLSAER0D4L85E - $750 Rebate 19259918 17803807 or 19299802 19258004 17803807 or 19299802 19301358 19299803 19257456 19300175 19259914 19302405 19260931 19302405 19258267 19302405 19302410 19125597 19260380 19259117 19259117 19259117 19259119 24217235 or 19299806 19299055 or 19260961 CPSLC94L70E - $500 Rebate CPSLS34L65E - $500 Rebate CPSLS74L70E - $750 Rebate 19259918 17803807 or 19299802 19301326 17803808 or 19299802 CPSL3765254L70E - $500 Rebate 19244098 19258553 19259914 19302405 19258270 19259117 19301360 19299803 19299055 19302405 19260961 19259117 19260380 19302405 19259261 19302405 19259117 19299802 or 19299803 19299055 19259117 CPSLC9ER0D4L65E - $500 Rebate CPSLS3ER0D4L65E - $500 Rebate CPSLSA4L85E - $750 Rebate 19258004 17803807 or 19299802 19257230 17803807 or 19299802 19260164 19302410 19260380 19302405 19260380 19302405 19259293 19259119 19259117 19259117 19300175 24217235 or 19299806 19125597 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.

*How did you rst hear about this offer? Online Mailer Dealership Employee Signs at the Dealership SEMA/Trade Show Other If you have not received your prepaid card within 8 weeks after the postmark date of your quali ed submission, or if you have questions about your submission, call (855) 806-3232 weekdays, 8am to 7pm CT. Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, , GMC, 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 offers, unless speci ed 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 disquali es 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 rst six months after the card is issued. Your card is issued by MetaBankTM, Member FDIC, pursuant to a license from Visa U.S.A. Inc. Cards can be used at any merchants that accept Visa debit cards within the United States and US Territories. 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.