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Black Pontiac Cadillac's GMOutlet

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Step # 1	Fill out this page by typing over the "fill in the blanks":
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Step # 3	Make check/credit card payable to:	Black Pontiac Cadillac
Step # 4	Mail/Fax this page & your check/credit card information to: Instructions: (4 Easy Steps)	Black Pontiac Cadillac 3929 Admiral Peary Hwy Ebensburg, Pa. 15931 Or Fax to: 1-814-472-4741

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, : Current Odometer

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$: GMPP List Price
$: GMPP Your Price
..: Sales Tax Help
$: Sales Tax Dollar Total
$: GMPP Surcharges (if applicable)
$: $50. Special Discount Expires 7/31/2010.
: GMPP Total Price

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(If problems with this form click here to go to totally blank form you first print & fill in by pen.)

Please apply for the selected General Motors Protection Plan and I authorize payment with my attached check/credit card information. I understand that for any reason the plan is changed or not offered on my vehicle (vehicle must be within the 3 year or 36,000 miles original manufacture warranty period – 4 year or 50,000 miles on all Cadillac Models) that my check/credit card will be returned/not charged and void this transaction. I understand that this plan is fully administered and funded (once activated by GM - approx. 2 weeks) by General Motors and is good in all 50 states (USA). I agree to all terms, benefits, conditions, and limitations of the plan - "General Motors Protection Plan - Major Guard". A small dealership processing & handling fee (Fee Lookup) will be added to the "GMPP Total Price". I understand that Non-Pennsylvania residents are "Sales Tax Exempt" because of the "Federal Sales Tax Ban" on Internet sales. Pennsylvania residents must pay the appropriate sales tax rate of 6% or 7% depending on your "Pennsylvania County Residence".

X_____________________________________Purchaser Signature on JULY / ____________ / 2 010

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