GET MY BONUS CONTACT INFORMATION

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1 Mail application and proof of eligibility documents to: 65 Clark Road North Battle Creek, MI ATTN: BonusDrive GET MY BONUS Now that you have your new vehicle, it s time to claim your bonus! Simply complete and submit the application below within 60 days of purchasing or leasing your new vehicle. Complete all information accurately. Information you provide is subject to a validation process to confirm the vehicle purchase or lease and your BonusDrive eligibility. Once your application is successfully submitted, you ll receive a check in the mail in approximately 8 10 weeks from approval and processing. All mailed in applications must be shipped through UPS or FedEx. Applicants must retain tracking information to validate date of entry along with a copy of the documentation that was submitted. CONTACT INFORMATION Contact information entered below must match the information shown on your dealership purchase or lease agreement. All information is required to submit application. FIRST NAME LAST NAME ADDRESS APT/SUITE CITY STATE ZIP PHONE AGE Page 1 of 5

2 VEHICLE INFORMATION First, please verify your vehicle is eligible on the BonusDrive website and list the Manufacturer and Model below. MAKE MODEL YEAR DATE OF PURCHASE OR LEASE VIN DEALERSHIP Page 2 of 5

3 BONUSDRIVE ELIGIBILITY BonusDrive is an exclusive automotive reward program that is only available to members of participating organizations and common household residents of members of those organizations. In this section we seek to verify that you or someone in your household is part of a participating organization. Please select the appropriate response for eligibility through insurance, employer or membership organization. INSURANCE ELIGIBILITY I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY INSURANCE I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY HOUSEHOLD MEMBER S INSURANCE Required proof of Insurance Company eligibility Please include a photocopy of one of the following documents with either yours or your household Insurance Identification Card Insurance Policy Declaration Page Certificate of Insurance Bill of Sale If insurance is through a household member, please also include a photocopy of BOTH you and your eligible household member s valid Driver s License to verify your common household address. Page 3 of 5

4 EMPLOYER ELIGIBLE I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY EMPLOYER I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY HOUSEHOLD MEMBER S EMPLOYER Required proof of Employer eligibility Please include a photocopy of a proof of eligibility document with either yours or your household Health Insurance Card Employee Badge of Identification Pay slip (may redact financial information) If employer is through household member, please include a photocopy of BOTH you and your eligible household member s valid Driver s License to verify your common household address. MEMBERSHIP ORGANIZATION ELIGIBLE (i.e., Credit Union Member, Bank Customer, Association Member) I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY MEMBERSHIP ORGANIZATION I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY HOUSEHOLD MEMBER S MEMBERSHIP ORGANIZATION Required proof of Membership Organization eligibility Please include a photocopy of a proof of eligibility document with either yours or your household Membership Organization Card Membership Organization Statement If membership is through a household member, please also include a photocopy of BOTH you and your eligible household member s valid Driver s License to verify your common household address. Page 4 of 5

5 DECLARATION By checking this box, I certify that all the information I have provided is accurate and truthful. I have read and agree to the Terms of Service. All submissions are subject to a verification process including phone calls to verify the information provided and additional information may be required. Any false or fraudulent claims are subject to prosecution. SURVEY Mail application and proof of eligibility documents to: 65 Clark Road North, Battle Creek, MI 49037, ATTN: BonusDrive What type of vehicle were you driving prior to this vehicle purchase (or lease)? On a scale of 1 to 4, where 1 means not very important and 4 means very important, how important was this offer in your purchase decision? How did you hear about BonusDrive? (Select one) Mailbox Employer Communications Website Search Other What other vehicles are in the household? Please list Make & Model. (List up to three) What other vehicles were you considering for purchase or lease? Please list Make & Model. (List up to three) Page 5 of 5