To receive your rebate, follow these conditions of acceptance:

1) Purchase a Genuine GM Parts Engine or Transmission for a 2012 or older Chevrolet, Cadillac, Buick, GMC,Pontiac, Oldsmobile, Saturn or Hummer (excludes Saab) vehicle and have it installed at a participating Chevrolet, Buick, GMC or Cadillac Dealer between April 1, 2018 and December 31, 2018.

2) Complete all information requested on this form accurately and legibly. Make a clean, legible copy of yourInvoice/Repair Order including the Dealer and circle the purchase(s).

3)

4)

Choose your rebate reward. Reward provided on a Visa® Prepaid Card or a Virtual Prepaid Mastercard®

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 not be required to upload your Invoice/Repair Order during the online submission process; however, if we are unable to validate your purchase you will be notified via email with instructions on how to proceed. Please keep copies of your Invoice/Repair Order until your submission is approved. To submit via mail: Mail this form, along with a copy of your GM Dealer Invoice/Repair Order to the address shown. Submission must be postmarked by January 1, 2019.

5) By providing your contact information below you consent that GM and/or a GM dealer may contact you withany GM offers and GM product information. For more information on the GM Privacy Statement please visitour website http://www.gm.com/privacy.

Offer Number 66071 PO Box 6970 Mesa, AZ 85216

(!) 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 FieldCustomer Information Section

*Invoice/Repair Order Number *Vehicle Year (must be 2012 or older)

*GM Part Number of Engine Purchased and Installed (Part Number is either 7 or 8 digits)

The 7 or 8 digit GM Part Number(s) found on your Invoice/Repair Order must be included on this form. If the Part Number(s) is not included on your Invoice/Repair Order, contact your GM dealer to obtain the required information.

___ ___ ___ ___ ___ ___ ___ ___*GM Part Number of Transmission Purchased and Installed (Part Number is either 7 or 8 digits) ___ ___ ___ ___ ___ ___ ___ ___

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*Dealership Name *Dealer Zip Code *Date of Purchase (MM/DD/YY)

*Vehicle VIN NumberEngine

Transmission

OR

To check the status of your rebate visit "Status Lookup" at www.mycertifiedservicerebates.com or call 844.656.5369 weekdays, 7 am to 11 pm Eastern Time. Please allow up to 8 weeks for rebate processing.

Offer valid for customers who make the purchase at a participating Chevrolet, Buick, GMC or Cadillac Dealer in the United States. 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. This offer is not valid on products being replaced under warranty. Fleet and commercial customers and GM Company Vehicles are not eligible for this offer. Internal dealership sales are not eligible for this offer. This offer cannot be combined with other General Motors offers. Limit one (1) rebate per service performed per service date and vehicle and 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. 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. General Motors reserves the right to substitute a check of equal value in lieu of a prepaid card at its discretion. Visa prepaid card is issued by MetaBank®, Member FDIC, pursuant to a license from Visa U.S.A. Inc. Can be used everywhere Visa debit cards are accepted. Virtual Prepaid Mastercard is issued by MetaBank®, Member FDIC, pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark, and the circles design is a trademark of Mastercard International Incorporated. Can be used online where Debit Mastercard is accepted. No cash access or recurring payments. 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. Terms and conditions apply, see MyPrepaidCenter.com/site/visa-promo or MyPrepaidCenter.com/site/Mastercard-virtual. Please allow up to 8 weeks for delivery of the rebate.

$200 GM Certified Service Powertrain Rebate Offer Offer Valid: 04/01/2018 - 12/31/2018

Choose Your Reward

Visa Prepaid Card Virtual Prepaid Mastercard *Virtual rewards will be sent electronically to the email address provided above and can be used to make online purchasesonly. If an email address is not provided, a physical card will be mailed.

Certified Service Powertrain RebateMail to:

TRANSMISSIONS EXCLUDES: Saab, Chevrolet Medium/Heavy Duty Trucks, GMC Medium/Heavy Duty Trucks , Chevrolet Performance crate engines and transmission.