MOPAIt MAIL-IN REBATES CLAIM FORM s 20 PLEASE TAKE ONE To receive your rebate(sl. you must: 1. Complete this Mopar Rebate Claim Form or a legible copy. 2. Attach the original dated Chrysler Group LLC franchise dealership retail repair order. (Keep a copy for warranty and personal records.) 3. Choose the rebate(s) for which you qualitv' 4. Send the completed Mopar Rebate Claim Form along with the original retail repair order to: Spring Rebate PO Box 5991 Kalamazoo MI 49003-5991 The product(s) purchased and dealer-installed on my vehicle between March 1, 2012, and May 31, 2012, include: General Tires Mopar Value Line or Magneti Marelli® Struts $40.00 mail-in rebate with purchase and installation $20.00 mail-in rebate with purchase and installation $20.00 mail-in rebate with purchase and installation per set of any four General Tires. per set of any two General Tires. per set of any two brand struts. Part Number: L...I..J.I---,-I....JI'--l..--'-..J.I---,-I ....J1'--l..1__;I Part Number: LI -,1__j_1--,-I -'--'---L.....l__j__j__j Part Number: LI _j1___L1---'.1--'-....l..._j_....L.....J..._..J..._J I Total: $ I Qty: I Total; $ I Total: s Goodyear'" Premium Tires Goodyear Tires Mopar Value Line or Magneti Marelli Shocks $70.00 mail-in rebate with purchase and installation $20.00 mail-in rebate with purchase and installation $10.00 mail-in rebate with purchase and installation per set of any four Goodyear Premium Tires. per set of any four Goodyear Tires. per set of any two brand shocks. Part Number: 1 1 1 I 1 1 I I Part Number: I I 1 I I 1 I I Part Number: I I 1 I I 1 I Total: s I Oty: I Total: s I Qty: I Total: $ PLEASE SEND MY MOPAR PARTS REBATE(S) TO:* *P.O. Box not acceptable for rebate redemption. r~m"'Serviee & Par'fsl !;'M"_;'~STI(l<K WITH THE SPECIALI!?T;~ !1! ~~~~.,q ~ JeeP, ~~~ Rebate Rules and Regulations: (1) Offer good only in U.S.A., except where prohibited by law. Chrysler Group LLC and its fulfillment company are not responsible for late, lost, mutilated, misdirected or postage-due requests. Multiple, illegible or incomplete requests will not be honored. Requests from groups, post office boxes or organizations will not be honored. Fraudulent submissions of multiple requests could result in federal prosecution under U.S. Mail Fraud Statute (19 USC, Sections 1341 and 1342). Offer good at participating dealer locations. With purchase and dealer installation: $40.00 rebate per set of four General Tires, or $20.00 rebate per set of two General Tires. $70.00 rebate per set of four Goodyear® Premium Tires, including Wrangler MT/R®with Kevlar", Eagle® ROF/EMT, Wranglerll> SilentArmor,® Assurance" TripleTred AS;," Assurance" CS TripleTred""AS, Eagle'" Fl All Season, Eagle'" F1 Asymmetric 2.'" all other Eagle® Fl Family, Ferrera" Triplc'Ired'" Fortera" HL':"'Fortera® Silent Armor," Fortera® SL'" and Wrangler® DuraTrac. $20.00 rebate per set of four Goodyear Tires not listed above. $20.00 rebate per set of $ two Mopar Value Line or Magneti Marelli Struts. $10.00 rebate per set at two Mopar Value Line or Magneti Marelli Shocks. Offer valid tor Chrysler, Jeep"" Dodge, Ram, GM, Ford, Honda, Toyota, Nissan, Hyundai and Kia vehicles. Ask your service advisor for details. Rebates valid on purchases from March 1. 2012 - May 31, 2012. All rebate requests must be postmarked by June 15,2012, and received by July 2, 2012. Please allow 8-10 weeks for delivery of rebate check. You may call Program Headquarters at (866) 940-9753 with inquiries about your rebate(s). See your service advisor tor details. Rebate offers valid for retail repair orders only. Goodyear and logo are registered trademarks of the Goodyear Tire & Rubber Company. Magneti Marelli is a registered trademark of Magneti Marelli S.p.A. Chrysler, Jeep"" Dodge, Ram, Mopar and SRT are registered trademarks of Chrysler Group LLC. © 2012 Chrysler Group LLC. All Rights Reserved..