$1000 Rebate Form

OEM Dealership Name(Required)

OEM Dealership Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Country(Required)

OEM Dealership Phone Number(Required)

OEM Dealership Email(Required)

OEM Dealership Address for Check(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Country(Required)

OEM Dealership W9 File Upload(Required)

Max. file size: 50 MB.

Customer Name(Required)

First Last

Customer Business Name(Required)

Customer Email(Required)

Customer Phone Number(Required)

Switch-N-Go Hoist Serial Number(Required)

Truck VIN(Required)

Truck Bill Of Sale(Required)

Accepted file types: pdf, Max. file size: 50 MB.

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Josh Oertly