Revision #1

Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, Buick, GMC, Cadillac dealer or a Powertrain retailer located in the United States. 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 not valid on products being replaced under warranty. This offer is for retail customers only. Fleet and commercial customers are not eligible for this offer. Internal dealership sales are not eligible for th is offer. This offer cannot be combined with any other General Motors offers, unless specified in writing by General Motors. Limit one (1) rebate 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. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USO) applies, but is waived for the first twelve months after the card is issued. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. 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.

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 EST.

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

Automatic Fuel-Injected Crate Powertrain SystemProgram Dates: 01/01/2017 - 12/31/2017Connect & Cruise Crate Powertrain Consumer RebateGM Visa® Prepaid Card Offer

Mail to:Connect & Cruise Powertrain RebateOffer Number 66016PO Box 6970Mesa, AZ 85216

To receive your Visa prepaid card by mail follow these conditions of acceptance:1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2017 and

December 31, 2017. Rebate limited to two per household.2) Complete all information requested on this form accurately and legibly.3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identification

and circle the purchase(s) .4) Mail a copy of your Invoice/Repair Order and this completed rebate form to the address

below. Submission must be postmarked by January 31, 2018.5) To check the status of your submission, visit the “My Rebate Status” section at

www.mycertifiedservicerebates.com.

Customer Information Section *Denotes Required Field

*Address

*First Name

*Dealership/Retailer Location *Dealership/Retailer Zip Code *Date of Service (MM/DD/YY) *Invoice/Repair Order Number

*Last Name

*City *State *Zip Code

Email Phone

All of the applicable 8 digit GM Part Numbers must be purchased on the same Invoice/Repair Order and must match what is checked on this form.

❏ Please check here if you would like to receive the Chevrolet Performance Fuel Newsletter. To read the GM Privacy Statement, go to www.gm.com/privacy.

Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order.LS/LT

❏ LC9 (5.3L) 2WD E-ROD$500 Rebate❏ 19258004 ❏ 19299802❏ 19260380 ❏ 19302405❏ 19259117

❏ LC9 (5.3L) 4WD E-ROD$500 Rebate❏ 19258004 ❏ 19299802❏ 19260961 ❏ 19302405❏ 19259117

❏ LS376/480$500 Rebate❏ 19259117 ❏ 19302405❏ 19299055 ❏ 19301358❏ 19299803❏ 19258267 or ❏ 19354330

❏ LS3 (6.2L) 2WD$500 Rebate❏ 19301326 ❏ 19299802❏ 19260380 ❏ 19302405❏ 19259117❏ 19258270 or ❏ 19354328

❏ LS3 (6.2L) 4WD$500 Rebate❏ 19301326 ❏ 19259117❏ 19260961 ❏ 19302405❏ 19299802❏ 19258270 or ❏ 19354328

❏ LS3 (6.2L) E-ROD$500 Rebate❏ 19257230 ❏ 19299802❏ 19260380 ❏ 19302405❏ 19259117

❏ LS376/525$500 Rebate❏ 19301360 ❏ 19302405❏ 19259117 ❏ 19299803❏ 19299055 or ❏ 24283281❏ 19259261 or ❏ 19354332

❏ LT1 (6.2L) Dry Sump$500 Rebate❏ 19329997 ❏ 19299802❏ 19303137 ❏ 19302405❏ 19329645 ❏ 19329416

❏ LT1 (6.2L) Wet Sump$500 Rebate❏ 19328728 ❏ 19299802❏ 19303137 ❏ 19302405❏ 19329645 ❏ 19329416

❏ LT1 (6.2L) E-ROD Wet Sump$500 Rebate❏ 12677008 ❏ 19302405❏ 19329645 ❏ 19329416❏ 19299802

❏ LT1 (6.2L) w/8 SpeedTransmission Wet Sump$500 Rebate❏ 19355405 ❏ 24284055❏ 19355167 ❏ 24283284

❏ LT4 (6.2L) Dry Sump$500 Rebate❏ 19332702 ❏ 19125817❏ 19331517 ❏ 19299802❏ 24283281 ❏ 19302405❏ 19329416

❏ LT4 (6.2L) Wet Sump$500 Rebate❏ 19332621 ❏ 19299802❏ 19331517 ❏ 19302405❏ 24283281 ❏ 19329416❏ 19125817

❏ LT4 (6.2L) w/8 SpeedTransmission Wet Sump$500 Rebate❏ 19355404 ❏ 24284063❏ 19355174 ❏ 24284144

❏ LT376/535$500 Rebate❏ 19355378 ❏ 19299803❏ 12677124 ❏ 19302405❏ 24283281 ❏ 19329416❏ 19125817

❏ LSA (6.2L) E-ROD$750 Rebate❏ 19257456❏ 19302410❏ 19259119❏ 19300175 or 24283281❏ 19299806

❏ LSA (6.2L) NON E-ROD$750 Rebate❏ 19331507❏ 19300175❏ 19302410❏ 19259119❏ 19299806❏ 19259293 or ❏ 19354336

❏ LS7 (7.0L)$750 Rebate❏ 19244098 or 19329246❏ 19302405❏ 19259117❏ 19299055 or ❏ 24283281❏ 19299802 or ❏ 19299803❏ 19258553 or ❏ 19354334

Revision #1

Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, Buick, GMC, Cadillac dealer or a Powertrain retailer located in the United States. 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 not valid on products being replaced under warranty. This offer is for retail customers only. Fleet and commercial customers are not eligible for this offer. Internal dealership sales are not eligible for th is offer. This offer cannot be combined with any other General Motors offers, unless specified in writing by General Motors. Limit one (1) rebate 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. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USO) applies, but is waived for the first twelve months after the card is issued. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. 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.

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 EST.

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

Automatic Carbureted Crate Powertrain SystemProgram Dates: 01/01/2017 - 12/31/2017Connect & Cruise Crate Powertrain Consumer RebateGM Visa® Prepaid Card Offer

Mail to:Connect & Cruise Powertrain RebateOffer Number 66016PO Box 6970Mesa, AZ 85216

To receive your Visa prepaid card by mail follow these conditions of acceptance:1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2017 and

December 31, 2017. Rebate limited to two per household.2) Complete all information requested on this form accurately and legibly.3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identification

and circle the purchase(s) .4) Mail a copy of your Invoice/Repair Order and this completed rebate form to the address

below. Submission must be postmarked by January 31, 2018.5) To check the status of your submission, visit the “My Rebate Status” section at

www.mycertifiedservicerebates.com.

Customer Information Section *Denotes Required Field

*Address

*First Name

*Dealership/Retailer Location *Dealership/Retailer Zip Code *Date of Service (MM/DD/YY) *Invoice/Repair Order Number

*Last Name

*City *State *Zip Code

Email Phone

All of the applicable 8 digit GM Part Numbers must be purchased on the same Invoice/Repair Order and must match what is checked on this form.

❏ Please check here if you would like to receive the Chevrolet Performance Fuel Newsletter. To read the GM Privacy Statement, go to www.gm.com/privacy.

Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order.

❏ 350/290 Deluxe$500 Rebate❏ 19244450 ❏ 19332781❏ 19260380❏ 19299800❏ 19332775

❏ 350 HO Turn-Key$500 Rebate❏ 19210009 ❏ 19332781❏ 19260380❏ 19299800❏ 19332775

❏ Ram Jet 350$500 Rebate❏ 12499120❏ 19332781❏ 19260380❏ 19299800❏ 19332775

❏ HT 383$500 Rebate❏ 19332529 ❏ 19332781❏ 19299055❏ 19299800❏ 19332775

❏ SP350/385 Base$500 Rebate❏ 19333157 ❏ 19332781❏ 19260380❏ 19299801❏ 19332775

❏ SP350/357 Turn-Key$500 Rebate❏ 19332781❏ 19260380❏ 19299800❏ 19332775

❏ SP350/385 Turn-Key$500 Rebate❏ 19333158❏ 19332781❏ 19260380❏ 19299801❏ 19332775

❏ SP383 Deluxe$500 Rebate❏ 19332532❏ 19332781❏ 19299055❏ 19299801❏ 19332775

❏ ZZ6 Base$500 Rebate❏ 19351532❏ 19332781❏ 19260380❏ 19299801❏ 19332775

Small Block Big Block

LS❏ LS 376/515

$500 Rebate❏ 19301359❏ 19259117❏ 19299055❏ 19299803❏ 19332775

❏ ZZ6 Turn-Key$500 Rebate❏ 19351533❏ 19332781❏ 19260380❏ 19299801❏ 19332775

❏ HT502$500 Rebate❏ 88890534❏ 19332784❏ 19300175❏ 19299804❏ 19332780

❏ 502 HO$500 Rebate❏ 12568778❏ 19332784❏ 19300175❏ 19299804❏ 19332780

❏ ZZ502/502 Deluxe$500 Rebate❏ 19331579❏ 19332784❏ 19300175❏ 19299805❏ 19332780

❏ Ram Jet 502$500 Rebate❏ 12499121❏ 19332784❏ 19300175❏ 19299805❏ 19332780

❏ ZZ572/620 Deluxe$750 Rebate❏ 19331583❏ 19332784❏ 19300175❏ 19299805❏ 19332780

❏ ZZ572/720R Deluxe$750 Rebate❏ 19331585❏ 19332784❏ 19300175❏ 19299805❏ 19332780

❏ ZZ427/480$500 Rebate❏ 19166393

or ❏ 19331572❏ 19332781❏ 19299055❏ 19299801❏ 19332775

❏ 454 HO$500 Rebate❏ 12568774❏ 19332784❏ 19300175❏ 19299804❏ 19332780

❏ ZZ454/440$500 Rebate❏ 19331574❏ 19332784❏ 19300175❏ 19299804❏ 19332780

Revision #1

Rebates are available to customers who have purchased the parts detailed above at a participating Chevrolet, Buick, GMC, Cadillac dealer or a Powertrain retailer located in the United States. 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 not valid on products being replaced under warranty. This offer is for retail customers only. Fleet and commercial customers are not eligible for this offer. Internal dealership sales are not eligible for th is offer. This offer cannot be combined with any other General Motors offers, unless specified in writing by General Motors. Limit one (1) rebate 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. Rebate paid in the form of a Visa prepaid card. The Visa prepaid card is not redeemable for cash or usable at any ATM. Terms and Conditions apply to the card. Subject to applicable law, a monthly maintenance fee of $3 (USO) applies, but is waived for the first twelve months after the card is issued. Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and managed by Citi Prepaid Services. Cards will not have cash access and can be used everywhere Visa debit cards are accepted. 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.

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 EST.

(!) IMPORTANT: Photocopy your entire submission for your records. You may be required to mail or fax these photocopies.

Manual Powertrain SystemProgram Dates: 01/01/2017 - 12/31/2017Connect & Cruise Crate Powertrain Consumer RebateGM Visa® Prepaid Card Offer

Mail to:Connect & Cruise Powertrain RebateOffer Number 66016PO Box 6970Mesa, AZ 85216

To receive your Visa prepaid card by mail follow these conditions of acceptance:1) Purchase a Chevrolet Performance Crate Powertrain system between January 1, 2017 and

December 31, 2017. Rebate limited to two per household.2) Complete all information requested on this form accurately and legibly.3) Make a clean, legible copy of your Invoice/Repair Order including the dealer identification

and circle the purchase(s) .4) Mail a copy of your Invoice/Repair Order and this completed rebate form to the address

below. Submission must be postmarked by January 31, 2018.5) To check the status of your submission, visit the “My Rebate Status” section at

www.mycertifiedservicerebates.com.

Customer Information Section *Denotes Required Field

*Address

*First Name

*Dealership/Retailer Location *Dealership/Retailer Zip Code *Date of Service (MM/DD/YY) *Invoice/Repair Order Number

*Last Name

*City *State *Zip Code

Email Phone

All of the applicable 8 digit GM Part Numbers must be purchased on the same Invoice/Repair Order and must match what is checked on this form.

❏ Please check here if you would like to receive the Chevrolet Performance Fuel Newsletter. To read the GM Privacy Statement, go to www.gm.com/privacy.

Check the box next to the Model and corresponding 8 digit GM Part Numbers for the system purchased on your Invoice/Repair Order.Small Block LS/LT

Big Block

❏ Ram Jet 350 (5.7L)$500 Rebate❏ 12499120❏ 19329900❏ 19352208

❏ SP383$500 Rebate❏ 19332532❏ 19329900❏ 19352208

❏ SP350/357 T/K$500 Rebate❏ 12677177❏ 19329900❏ 19352208❏ 19332775

❏ SP350/385 T/K$500 Rebate❏ 19333158❏ 19329900❏ 19352208

❏ ZZ427/480$500 Rebate❏ 19166393 or 19331572❏ 19329902❏ 19352208

❏ LC9 (5.3L) - E-ROD$500 Rebate❏ 19258004❏ 19301625❏ 19352208

❏ LS3 (6.2L)$500 Rebate❏ 19301326❏ 19352208❏ 19301625❏ 19258270 or 19354328

❏ LS3 (6.2L) - E-ROD$500 Rebate❏ 19257230❏ 19301625❏ 19352208

❏ LS376/480$500 Rebate❏ 19301358❏ 19301625❏ 19352208❏ 19258267 or 19354330

❏ LS376/515$500 Rebate❏ 19301359❏ 19301625❏ 19352208

❏ LS376/525$500 Rebate❏ 19301360❏ 19301625❏ 19352208❏ 19259261 or 19354332

❏ LSA (6.2L) - NON E-ROD$750 Rebate❏ 19331507❏ 19352208❏ 19329912❏ 19259293 or 19354336

❏ LSA (6.2L) - E-ROD$750 Rebate❏ 19257456❏ 19329912❏ 19352208

❏ LS9 (6.2L)$750 Rebate❏ 19260165❏ 19352208❏ 19331083❏ 19299462 or 19354338

❏ LT4 (6.2L) - Wet$500 Rebate❏ 19332621❏ 19331517❏ 19329912❏ 19352208

❏ LT4 (6.2L) - Dry$500 Rebate❏ 19332702❏ 19331517❏ 19329912❏ 19352208

❏ LT376/535 (6.2L)$500 Rebate ❏ 19355378❏ 12677124❏ 19352208❏ 19329912

❏ 427 Anniversary$750 Rebate❏ 19166392❏ 19329902❏ 19352208

❏ ZZ454/440$500 Rebate❏ 19331574❏ 19329901❏ 19352208

❏ ZZ502$500 Rebate❏ 19331579❏ 19329901❏ 19352208

❏ LS7 (7.0L)$750 Rebate❏ 19244098 or 19329246❏ 19301625❏ 19352208❏ 19258553 or 19354334

❏ LT1 (6.2L) - Wet$500 Rebate❏ 19328728❏ 19303137❏ 19329912❏ 19352208

❏ LT1 (6.2L) - Dry$500 Rebate❏ 19329997❏ 19303137❏ 19329912❏ 19352208

❏ Ram Jet 502$500 Rebate❏ 12499121❏ 19329901❏ 19352208

❏ ZZ572/620 Deluxe$750 Rebate❏ 19331583❏ 19329902❏ 19352208