Mail application and proof
of eligibility documents to:
BonusDrive Promotion
PO Box 5010
Kalamazoo, MI 49003-5010
GET MY $500
Now that you have your new vehicle, it’s time to claim your $500 rebate! 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 6 weeks from approval and processing.
CONTACT INFORMATION
Contact information entered below must match the information shown on your dealership
purchase or lease agreement.
FIRST NAME
LAST NAME
ADDRESS
APT/SUITE
CITYSTATE
ZIP
EMAILPHONE
AGE
VEHICLE INFORMATION
First, please verify your vehicle is eligible on the BonusDrive website and list the Manufacturer and
Model below.
MAKEMODEL
YEARVIN
2016
2017
2018
DATE OF PURCHASE OR LEASE
DEALERSHIP
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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 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
- OR -
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
member’s name clearly visible.
• Insurance Identification Card
• Insurance Policy Declaration Page
• Certificate of Insurance
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.
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EMPLOYER ELIGIBLE
I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY EMPLOYER
- OR -
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
member’s name clearly visible.
• 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, Association Member)
I AM ELIGIBLE FOR BONUSDRIVE THROUGH MY MEMBERSHIP ORGANIZATION
- OR -
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
member’s name clearly visible.
• 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.
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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.
Mail application and proof of eligibility documents to:
BonusDrive Promotion, PO Box 5010, Kalamazoo, MI 49003-5010
SURVEY
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?
1
2
3
4
How did you hear about BonusDrive? (Select one)
Mailbox
Email
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)
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