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CAM Rebate Claim Form CAM member information Company: ____________________________________________________________________________________ Contact Name: _________________________________________Title: ___________________________________ Mailing Address: _______________________________________________________________________________ City: ________________________Province: _________________________Postal Code: _____________________ Telephone Number: ( ) _____________________________ Truck information VIN Number:__________________________________________ Date of Purchase: ______________________________________ Please Fax or mail this completed form with copies of your NVIS Card Western Star / CAM Rebate Offer Canadian Association of Movers 2200 Sherobee Road, Suite 404 Mississauga, Ontario, Canada L5A 3Y3 Fax: 905-848-8499 Claims CANNOT be processed without these qualifying documents: The Completed Rebate Claim form and copy of the NVIS Card must be received within 30 days of purchase to be eligible for rebate. Disclaimer: Rebate subject to program terms, confirmation of CAM membership status, and receipt of completed claim form and all qualifying documents, and valid only for new Western Star 4900 Series truck models (new order or dealer stock) delivered before 12/31/2009. Western Star reserves the right to modify or terminate this program at any time and without notice. This rebate program may not be combined with any other program. No modification to rebate program incentives or substitutions for program incentive permitted. Western Star is not responsible for schedule changes initiated by the customer, dealer, Daimler Trucks North America, or suppliers that may affect trucks otherwise qualifying for this program. Western Star Trucks Sales, Inc. is a subsidiary of Daimler Trucks North America LLC. Daimler Trucks North America is a Daimler company. Please allow 6-8 weeks from receipt of documents to receive rebate. Western Star Trucks Sales, Inc. is a subsidiary of Daimler Trucks North America LLC, a Daimler company.