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To receive your Visa Prepaid Card by mail follow these conditions of acceptance: 1) Purchase a dexos1® Oil Change, 4-Tire Rotation, and Multi-Point Vehicle Inspection and/or purchase and installation of an Original Equipment or ACDelco Professional Cabin Air Filter at a participating Chevrolet, Buick, GMC or Cadillac dealer between November 1, 2016 and November 30, 2016. 2) Complete all information requested accurately and legibly. For faster processing you can also submit online at www.mycertifiedservicerebates.com and follow the instructions. 3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identification and circle the purchase(s) and installation of the qualifying service. 4) Mail the copy of your Invoice/Repair Order and this completed rebate form to the address below. Submission must be postmarked by December 31, 2016. Mail to: Oil Change or Cabin Air Filter Rebate Offer Number 66018 PO Box 6970 Mesa, AZ 85216 Program Dates: 11/01/2016 - 11/30/2016 Receive up to a $20 Prepaid Card on an Oil Change and Cabin Air Filter Replacement (!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies. *First Name *Last Name *Address *City *State *Zip Code Email Phone *Denotes Required Field Customer Information Section *Dealership Name *Dealer Zip Code *Date of Service (MM/DD/YY) *Invoice/Repair Order Number *VIN Number As a U.S. resident, I would like to receive further communications from GM or a GM dealer. Non-U.S. residents please visit your country specific GM website and/or your local dealer for further information. *How did you first hear about this offer? Signs Inside the Dealership Other Where do you normally have your vehicle serviced? Dealership Home Local Independent Service Chain Firestone NTB Pep Boys Sears Valvoline Wal-Mart Midas Other Online Mailer Radio Dealership Employee Signs Outside the Dealership 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, you may visit www.mycertifiedservicerebates.com or call (844) 656-5369 weekdays, 8am to 7pm CT. Offer valid 11/1/2016-11/30/2016. For retail customers only. See participating U.S. dealer for details and rebate form, which must be postmarked by 12/31/16. Allow 6 to 8 weeks for delivery of reward card. Separate Oil Change, Tire Rotation, MPVI, and Cabin Air Filter Rebates - $10 Reward Card on the purchase of a dexos1 ® Oil Change, 4-Tire Rotation, and Multi-Point Vehicle Inspection and/or $10 Reward Card on the purchase and installation of an Original Equipment or ACDelco Professional Cabin Air Filter. Combined Oil Change, Tire Rotation, MPVI & Cabin Air Filter Rebates ($20 Combo) - $20 Reward Card on the purchase of a dexos1 ® Oil Change, 4-Tire Rotation, Multi-Point Vehicle Inspection, and a Cabin Air Filter with installation. Rebates are available to customers who have the service performed at a participating Buick, Cadillac, Chevrolet or GMC dealer located in the United States. Approved rebate submissions will receive a Visa prepaid card in US funds. 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 for retail customers only. Internal dealership sales are not eligible for this offer. Maximum of two (2) rebates per address for this promotion. Limit one (1) rebate (maximum of $10) 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 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. You should retain copies of your rebate submission for your records. Oil Change, 4-Tire Rotation, and Multi-Point Vehicle Inspection - $10 Rebate Installed Cabin Air Filter - $10 Rebate Combined Oil Change, Tire Rotation, MPVI & Installed Cabin Air Filter - $20 Rebate *GM Part Number of OIL FILTER Purchased and Installed ___ ___ ___ ___ ___ ___ ___ ___ *GM Part Number of CABIN FILTER Purchased and Installed ___ ___ ___ ___ ___ ___ ___ ___ Select one of the following:
