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September 4, 2017 – October 1, 2017 PEP BOYS VISA ® PREPAID CARD REBATE CLAIM FORM (CANNOT BE COMBINED WITH ANY OTHER OFFER) Rebate Limit Rebate Total Product ANTIFREEZE Rebate Amount Item Qty. Peak 33% AF (#PKABW8) Peak Final Charge 50/50 (#FXA053) Peak Long Life FS (#PRA003) Peak Long Life 50/50 (#PRA053) $5.00 $5.00 $5.00 $5.00 4 4 4 4 Rebate Limit Rebate Total Product AIR FILTERS Rebate Amount Item Qty. Purchase 1 Purolator Air Filter or 1 Purolator Cabin Filter $4.00 2 Rebate Limit Rebate Total Product BODY REPAIR Rebate Amount Item Qty. Herculiner Truck Bed Liner Kit (#HCL1B8) $25.00 1 Rebate Limit Rebate Total Product EXTERIOR ACCESSORIES Rebate Amount Item Qty. Lund Ventvisors (various #s) Lund Bugflector II (various #s) $10.00 $10.00 2 2 Page 1 of 2 Mail to: Pep Boys September 2017 Rebates PBA-170901 PO Box 750608 El Paso, TX 88575-0608 Get exclusive online SERVICE, PARTS, TIRES and ACCESSORY offers at pepboys.com CONDITIONS OF ACCEPTANCE: To be legally entitled to receive the rebate payment, you must: 1. Purchase any of the listed products at a Pep Boys store between September 4, 2017 – October 1, 2017. 2. Circle the qualifying items on the REGISTER RECEIPT or INVOICE (We cannot accept a Work Order). 3. Complete, sign and date this form. To be eligible for this offer, you must indicate the Quantity Purchased and Rebate Total for all selected items within this form. Ensure all requested information is filled in accurately, legibly and completely. 4. Submit: Online at: http://www.pepboys.com/rebates OR Mail to address below -- be sure to include a completed and signed Claim Form AND your Pep Boys REGISTER RECEIPT or INVOICE (NOT the work order). 5. Requests must be submitted or postmarked within thirty (30) days from date of purchase. 6. Make copies of all rebate submission materials for your records. Any disputed claim will require photocopy substantiation. 7. Understand and agree that the rebate will be the value of all valid rebates on a Pep Boys Visa Prepaid Card issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. Terms & Conditions: Offer valid for purchases at Pep Boys locations in the continental United States. Visa Prepaid Cards will be paid in United States dollars only to United States residents. Rebate Offer cannot be combined with any other offer, rebate or discount. Pep Boys is not responsible for lost, damaged or incomplete Rebate Claim Forms or for misprints or typo-graphical errors. Offer is void where restricted or prohibited. All federal, state and local taxes are the responsibility of the Rebate recipient. Rebate Limit(s) apply per product, per person. To receive your Rebate, you must satisfy all the Conditions of Acceptance (above). Failure to comply with any of these Conditions of Acceptance will result in a rejection of this Rebate Claim Form. Any inquiries concerning disputes or claims of non-payment must be made by 1/20/18 and will require photocopy(s) of receipt(s) and completed mail-in Rebate Claim Form. Any such disputes will be governed by the laws of the State of Minnesota. Failure to use your Visa Prepaid Card shall void the Rebate Claim and will relieve Pep Boys of any obligation or liability to pay the rebate. Fraudulent submissions including multiple requests could result in federal prosecution under the U.S. Mail Fraud Statutes (Title 18, USC 1341 and 1342). Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Visa Prepaid Cards cannot be redeemed for cash and cannot be used for cash withdrawals. Visa Prepaid Cards can be used everywhere Visa debit cards are accepted. Visa Prepaid Cards expire 120 days after the date of issuance, which date will be shown on the front of each Card. If you have not received your rebate after 8 to 10 weeks, please call 1-888-829-1420, Monday-Friday, 7AM – 7PM CST or check your rebate status at: http://www.pepboys.com/rebates/. Name Address State ZIP City Phone ( ) Please Print Clearly: Must be signed and dated Signature Please Sign Your Name Here By completing this rebate request, I accepted and complied, or will comply with all of the Conditions of Acceptance for this rebate offer. E-mail I would like to receive e-mail from Pep Boys on product promotions and other Pep Boys services. Date Submit online at: http://www.pepboys.com/rebates Rebate Limit Rebate Total Product ACCESSORIES AND LIGHTING Rebate Amount Item Qty. 12' x 26' Canopy (#30777) 10'X20' Auto Shelter (#62680) 10'x20' Carport Canopy (#25757) Voyager 18cu ft. Abs Cargo Bx (#90274) Bondtech Truck and SUV Covers (Various #'s) Premiumtech/Barret Jackson Car Covers (various #'s) Premiumtech/Barret Jackson Truck/SUV Covers (various #'s) Philips Vision Twin Pack Headlamps (various #'s) Phillips VisionPlus Twin Pack Headlamps (various #'s) Philips Xtreme Vision Twin Pack Headlamps (various #'s) Buy 2 Rain-X Latitude Water Repellency Beam Wiper Blades (various #s) $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $7.00 $10.00 $15.00 $10.00 1 1 1 2 2 2 2 2 2 2 2 Rebate Limit Rebate Total Product JUMPSTART Rebate Amount Item Qty. Pilot Lightning Lithium-ion Jumpstart (#CA-9802) Autolectric 12K MAH Lithium-ion Jumpstart (JMP12GPBL) Autolectric 14K MAH Lithium-ion Jumpstart (#JMP14GPBL) $20.00 $20.00 $20.00 2 2 2
