$250 Chevrolet Performance Visa® Prepaid Card Offer Chevrolet Performance Holeshot Rebate Offer Offer Valid: 11/01/2017 - 12/31/2017 To receive your Visa prepaid card by mail follow these conditions of acceptance: 1) Purchase a Chevrolet Performance crate engine or Chevrolet Performance transmission between November 1, 2017 and December 31, 2017. 2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of your Invoice/Repair Order including the GM Dealer name or Chevrolet Performance authorized Powertrain reseller and circle the purchase(s). 3) Submit your rebate on-line for faster processing or via mail. To submit on-line: Use a computer, tablet or mobile phone, go to www.mycertifiedservicerebates.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 Invoice/Repair Order, to the address below. Submission must be postmarked by January 31, 2018. 4) By providing your contact information below, you consent that GM and/or a GM dealer can contact me 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 or call 1-866-MYPRIVACY(1-866-697-7482). Mail to: Chevrolet Performance Holeshot Rebate Offer Number 66043 PO Box 6970 Mesa, AZ 85216 Customer Information Section *Denotes Required Field *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 Location *Dealer Zip Code *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number *GM Part Number of Chevrolet Performance Crate Engine Purchased and Installed (Part Number is either 7 or 8 digits) Engine ■ ___ ___ ___ ___ ___ ___ ___ ___ OR *GM Part Number of Chevrolet Performance Transmission Purchased and Installed (Part Number is either 7 or 8 digits) Transmission ■ ___ ___ ___ ___ ___ ___ ___ ___ Please refer to the back of the form for a complete listing of eligible parts. Lookup Offer valid for customers who have purchased the part detailed above at participating Chevrolet, Buick, GMC or Cadillac dealer or a Chevrolet Performance authorized Powertrain reseller located in the United States. A listing of the Chevrolet Performance Authorized Powertrain Resellers can be found at chevroletperformance.com/resources. The customer must take delivery of the Chevrolet Performance parts during the offer period to be eligible for the rebate. Maximum 3 rebates per customer. Only one rebate allowed for each Chevrolet Performance engine or transmission purchased. Approved rebate submissions will receive a Visa® prepaid card. 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 customers with mailing addresses in the United States and U.S. territories. Internal dealership sales are not eligible for this offer. Chevrolet Performance Authorized Resellers are not eligible for this offer. This offer cannot be combined with other General Motors offers. 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. 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 the property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. 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 12 months; unused funds will be forfeited at midnight Eastern Time the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. 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. Please confirm that the corresponding 8 digit GM Number for the Chevrolet Performance crate engine and/or Chevrolet Performance transmission purchased is printed on your Invoice/Repair Order Chevrolet Performance Engines 19258602 ENGINE ASM, 350HP CIRCLE TRACK 19355404 ENGINE ASM, LT4 PERFORMANCE PARTS W/DIGITAL SENSOR 19301326 ENGINE, (PRODUCTION LS3) 19367080 ENGINE ASM, SP350/357C BASE ENGINE 19301360 ENGINE, LS376/525 EFI 19328728 ENGINE ASM, PERFORMANCE PARTS LT1 (CORVETTE WET SUMP) 19318604 ENGINE ASM,CT400 WITH NEW FASTBURN HEADS 19329246 ENGINE ASM, CAMARO LS7-CHEVROLET PERFORMANCE 19301358 ENGINE, LS376/480 88890534 ENGINE, HT502 BIG BLOCK 19210009 ENGINE ASM, 350 HO TURN KEY W/670 HOLLEY 19257234 ENGINE ASM, LS3 E-ROD, (FOR 17 TOOTH TRANS RELUCTOR) 19210008 ENGINE ASM, 350 HO DELUXE W/670 HOLLEY CARB 19355719 ENGINE ASM, 383 PARTIAL ENGINE WITH SCAT ROD 19355658 ENGINE ASM, 350/290 BASE 12499121 ENGINE, RAM JET 502 19210007 ENGINE, 350HO BASE ASM 19355659 ENGINE ASM, 350/290 DELUXE UNASSEMBLED KIT 19351533 ENGINE ASM, ZZ6 TURN KEY 12498778 ENGINE,ZZ454 PARTIAL 19331579 ENGINE ASM,CHEVROLET PERFORMANCE ZZ502 DELUXE 19367082 ENGINE ASM, SP350/357C DELUXE ENGINE ASSEMBLY 19355722 ENGINE ASM, SP383 ENGINE ASSEMBLY WITH SCAT ROD 12670966 ENGINE ASM-GASOLINE (PARTIAL ENGINE - PERFORMANCE) 19331574 ENGINE ASM,CHEVROLET PERFORMANCE ZZ454 19201334 ENGINE ASM,ZZ572 DELUXE 720 HP W/1150 HOLLEY CARB 19331507 ENGINE ASM, LSA (6.2L SUPERCHARGED-CAMARO PP) 19328586 ENGINE ASM,8.0 L (488 CID),CRATE ENGINE 19333158 ENGINE ASM, SP350 TURN-KEY 19257456 ENGINE ASM, LSA E-ROD, (FOR AUTO TRANS, 40T) 12568774 ENGINE,7.4L(454 CID) 19260835 ENGINE, (PERF. PARTS LSX454R RACE ENG.) 19351532 ENGINE ASM, ZZ6 BASE 19332527 ENGINE ASM,PARTIAL, 383 CRATE 19332621 ENGINE ASM, LT4 WET SUMP (CADILLAC_ANALOG FUEL SENSOR) 19355405 ENGINE ASM, LT1 PERFORMANCE ENGINE W/DIGITAL SENSOR 19355573 ENGINE ASM, LSX454 KIT 19332312 ENGINE ASM, LSX376-B8 LONG BLOCK KIT 19355815 ENGINE KIT,RAM JET 350 WITH 1.5 ROCKER ARMS 19367084 ENGINE ASM, SP350/357C TURNKEY ENGINE ASSEMBLY 19257230 ENGINE, LS3 EROD - (W/40 TOOTH TRANS. RELUCTOR) 19328837 ENGINE ASM, 2.0L TURBO CHEVY PERFORMANCE 12568778 ENGINE ASM, CHEVROLET PERFORMANCE 502 HO 19331581 ENGINE ASM,CHEVROLET PERFORMANCE 572/620 BASE 12561723 ENGINE,GASOLINE (GMPP NEW) 19329008 ENGINE ASM, (PERF. PARTS DR525 F-CAR PAN) 19333157 ENGINE ASM, SP350 BASE 19355378 ENGINE ASM,6.2 L LT376/535 19331563 ENGINE ASM,6.2L CHEVROLET PERFORMANCE CT525 19329009 ENGINE ASM, (PERF. PARTS DR525 MUSCLE CAR PAN) 19355575 ENGINE ASM, LSX376-B15 KIT 19201333 ENGINE, ZZ572/620 DELUXE 19331572 ENGINE ASM,CHEVROLET PERFORMANCE ZZ427 19244102 ENGINE ASM, L99 19331576 ENGINE ASM,CHEVROLET PERFORMANCE ZZ502 BASE 19257460 ENGINE ASM, LSA E-ROD, (FOR MAN TRANS, 17T) 19331583 ENGINE ASM,CHEVROLET PERFORMANCE 572/620 DELUXE 12677823 ENGINE KIT-GASOLINE 2017/DIG FWD LTG CRATE 19355720 ENGINE ASM, HT383 ENGINE ASSEMBLY WITH SCAT ROD 12682080 ENGINE KIT-LT1 E-ROD (CAMARO BASED) 19301359 ENGINE, LS376/515 CARBURETOR ENGINE 19165488 ENGINE ASM, 12568782 ENGINE,CHEVROLET PERFORMANCE 502 PARTIAL 19244805 ENGINE, 19355721 ENGINE ASM, HT383E ENGINE ASSEMBLY WITH SCAT ROD 19329997 ENGINE ASM, CHEVY PERFORMANCE (LT1-DRY SUMP) 19260165 ENGINE ASM, LS9 PERF. PARTS 19331585 ENGINE ASM,CHEVROLET PERFORMANCE 572/720 DELUXE 19332702 ENGINE ASM, LT4 DRY SUMP (CORVETTE) 12623486 ENGINE ASM-6.2 L (379 CID) Chevrolet Performance Transmissions 19260380 TRANSMISSION KIT, (4L65) GMPP 19156259 TRANSMISSION ASM, 19299055 TRANSMISSION PKG,AUTO SUPERMATIC 4L70 2WD 19328976 TRANSMISSION PKG,MAN M3L 6SPD CRATE LTG 4CYL TURBO-RWD 19352208 TRANSMISSION PKG,MAN T56 MAGNUM 24283284 TRANSMISSION KIT-AUTO LT1 8SPD INSTALL KIT 19300175 TRANSMISSION ASM, 4L85E SUPERMATIC REMAN W/O T/C 24283758 TRANSMISSION KIT-MAN LTG FWD INSTALL KIT 19332781 TRANSMISSION INSTALL KIT 4L60FAM TO SB/BB 24284070 TRANSMISSION KIT-MAN LTG FWD 6 SPD 19260961 TRANSMISSION PKG,AUTO 4L70 SUPERMATIC 4WD 24284093 TRANSMISSION KIT-AUTO LTG 2.0 TURBO 4L65E 19332784 TRANSMISSION INSTALLATION KIT 4L80FAM TO BIG BLOCK 19368611 Reman - TRANSMISSION KIT, (4L65) GMPP 24284063 TRANSMISSION KIT-AUTO LT4 8SPD TRANS KIT 19368612 Reman - TRANSMISSION PKG,AUTO 4L70 SUPERMATIC 4WD 24283281 TRANSMISSION KIT-AUTO 4L75E 19368613 Reman - TRANSMISSION PKG,AUTO SUPERMATIC 4L70 2WD 24284144 TRANSMISSION KIT-AUTO LT4 8SPD INSTALL KIT 19368614 Reman - TRANSMISSION PKG,AUTO SUPERMATIC 4L70 2WD 19356329 TRANSMISSION KIT-AUTO LT1 8SPD TRANS KIT 19368615 Reman - TRANSMISSION KIT-AUTO 4L75E 19156257 TRANSMISSION, 19368645 Reman - TRANSMISSION KIT-AUTO LTG 2.0 TURBO 4L65E 19329645 TRANSMISSION PKG,AUTO SUPERMATIC 4L70 2WD.