Subject
*
Retail Salesperson
*
Home Address
*
City
*
State
*
ZIP
*
SSN (if 1st submission):
Date
Dealer Name
*
Dealer Address
*
City
*
State
*
ZIP
*
Is this 1st submission for dealer?
Yes
No
Model Number of Units on Display
Model Number
*
Serial Number
*
Customer Name
*
Date Delivered
*
Dealer Invoice
*
SPIFF Amount
*
SUBMIT