$10/$20 GM Certified Service Prepaid Card Offer ACDelco Advantage and Professional Battery Rebate Offer Valid: 01/01/2018 - 02/28/2018 To receive your Visa® prepaid card by mail, follow these conditions of acceptance: 1. To qualify for the $10 mail-in battery rebate, purchase and have installed an ACDelco Advantage or Professional Battery at a participating Chevrolet/Buick/GMC/Cadillac Dealer during the promotion dates listed above. To qualify for the $20 rebate, the purchase must be made with your GM BuyPower Card. 2. Complete all information requested on this form accurately and legibly. Make a clean, legible copy of the GM Dealer Invoice/ Repair Order. The invoice/Repair Order must have the Dealer and eligible part purchase circled. If you used your GM BuyPower Card for your purchase, you will also be required to submit a copy of your credit card receipt. 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 and GM BuyPower Card credit card receipt, if applicable. To submit via mail: Mail this form, along with a copy of your GM Dealer Invoice/Repair Order and GM BuyPower Card credit card receipt, if applicable, to the address below. Submission must be postmarked within 30 days of purchase date. 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: Certified Service Battery Rebate Offer Number 66053 PO Box 6970 Mesa, AZ 85216 *GM BuyPower Cards include the GM Blue/Gold Card, GM Copper/Platinum Card, GM Extended Family Card and GM Flexible Earnings Card. Customer Information Section *Denotes Required Field *First Name *Last Name *Address *City *State *Zip *Phone Number *Email (!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies. *Dealer Name *Dealer Address *Date of Purchase (MM/DD/YY) *Invoice/Repair Order Number *Vehicle VIN Number *Last 4 Digits of your GM BuyPower Card *Amount Charged to your GM BuyPower Card By filling out these fields, I acknowledge that I am identifying myself as a GM BuyPower Card holder. Google/Internet Search Direct Mailer Pandora Ad Dealership Employee How did you first hear about this offer? Dealership Website Signs Inside the Dealership Television Other Dealership Pep Boys Local Independent Service Chain Where do you normally purchase batteries? Sears Walmart Midas Other Please check the rebate you are applying for: Purchased ACDelco Advantage and Professional Battery Purchased ACDelco Advantage and Professional Battery using my GM BuyPower Card $10 Rebate $20 Rebate Part Number ___ ___ ___ ___ ___ ___ ___ ___ Part Number ___ ___ ___ ___ ___ ___ ___ ___ 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 Eastern Time. Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer located in the United States and U.S. territories. 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 retail customers with mailing addresses in the United States and U.S. territories. This offer is not valid on products being replaced under warranty. GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. 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 and may give rise to criminal or civil prosecution. 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 property of General Motors and will not be returned. Rebate paid in the form of a Visa prepaid card. General Motors reserves the right to substitute a check of equal value in lieu of a Visa prepaid card at its discretion. 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 EST the last day of the month of the valid thru date. Card terms and conditions apply; see MyPrepaidCenter.com/site/visa-promo. Please allow up to 8 weeks for delivery of the rebate. .