GM Customer Incentive and Onstar Acknowledgement

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GM CUSTOMER INCENTIVE AND ONSTAR ACKNOWLEDGEMENT

CUSTOMER NAME:__________________________________________________________________________________________

VIN:________________________________________________________________________

1. Customer Incentive
I assign the total amount of customer incentive(s) listed to the dealer named below and request that the available customer incentive(s) be applied:
(a)____to the down payment of this vehicle, (b)___ where permissible by law, as a price reduction (Bill of Sale indicates pre-incentive price, amount of
incentive, and final price with incentive applied), or (c)____ a check be issued in my name by Dealer named below:

Incentive Program Reference Amount GM Incentive Code


___________________________________ $___________ ______________________________
___________________________________ $___________ ______________________________
___________________________________ $___________ ______________________________
___________________________________ $___________ ______________________________
___________________________________ $___________ ______________________________
Total Incentive Amount Received $___________

2. Other Program Selection (Which may or may not be in lieu of customer allowance programs; for example, Division supported financing/leasing, etc.)
I elect to receive the following in lieu of______________________ .
AND/OR
I elect to receive_________________________________________________________.

Vehicle Incentive Acknowledgement. I am the ultimate purchaser or lessee of the vehicle bearing this vehicle identification number, which
was sold/leased to me by the Dealer, named below. This vehicle was purchased/leased for personal/business use and not resale and I took
delivery on___/__/__ . I acknowledge receipt of incentive(s) as described in Item____ and release GM Division from any future claim or
obligation for incentive(s) on this unit.

Purchaser/Lessee Signature:________________________________________ Date:___/___/___


Authorized Dealer Signature:_______________________________________ Date:___/___/___

Dealership Name:__________________________________________ Dealer Code:__________

OnStar Acknowledgement
Is vehicle equipped with OnStar ? ______ Yes ______ No

Terms and Conditions Acknowledgement.


I acknowledge that I have received the Terms and Conditions under which the OnStar service in my vehicle is provided (copies are available in the
vehicle glovebox, from the dealer, at www.onstar.com, or by contacting OnStar as described below).
OnStar Stolen Vehicle Slowdown Capability (Model Year 2009 or Newer)
My OnStar-equipped vehicle may have Stolen Vehicle Slowdown capability that enables OnStar to slow down my stolen vehicle remotely to assist
authorities in its recovery.
I understand I must press the blue OnStar button and request the OnStar advisor to disable this capability if I don’t want the Stolen vehicle Slowdown
capability on my vehicle. This capability can only be re-enabled at a GM dealership at my expense.
Cancellation of All OnStar Services:
I understand that to cancel all the OnStar services in my vehicle, I must press the blue OnStar button in my vehicle or call 1.888.4OnStar
(1.888.466.7827)or TTY 1.877.248.2080 and request that my Services be cancelled.
Purchaser/Lessee Signature:________________________________________ Date:___/___/___
The undersigned person, as Dealer representative, certifies that the information on this application is true and correct, and the incentive(s) described in
Item #1; the OnStar Terms and Conditions; OnStar Stolen Vehicle Slowdown Capability and Cancellation of All OnStar Services have been
provided to the said purchaser/lessee who has taken delivery of referenced unit through this dealership, and that properly completed accurate
delivery data has been forwarded to General Motors.

Authorized Dealer Signature:_______________________________________ Date:___/___/___

Dealership Name:__________________________________________ Dealer Code:__________

Dealer Note: This is a required document and it must be completed, signed and retained in EVERY DEAL FILE for all customers even if there are no
incentives or rate support available. A copy of the completed form should be provided to the customer.

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