2016 Bridgestone FALL promotion

OFFICIAL CLAIM FORM PURCHASE BETWEEN: OCTOBER 1-31, 2016

File Your Reward Claim Online at BRIDGESTONEREWARDS.COM OR Mail In (see details below):
MAIL TO:
BRIDGESTONE REWARDS
ALL SUBMISSIONS MUST BE FILED ONLINE AT BRIDGESTONEREWARDS.COM OR POSTMARKED NO LATER THAN NOVEMBER 10, 2016. PO BOX 37605
ORIGINAL, FULLY COMPLETED, FINAL PAID & STORE-IDENTIFIED INVOICE MUST BE SUBMITTED WITH THIS CLAIM FORM. BOONE, IA 50037-0605

REWARD:
First Name (PLEASE PRINT CLEARLY) Last Name

Mailing Address
$70 Bridgestone Visa Prepaid Card. Offer Code:

BFALLUS2016
City State Zip Code
I would like to receive future Bridgestone email and/or
Email Address (REQUIRED FOR COMMUNICATION)
YES! marketing updates and promotions via
(CHARGES FROM YOUR MOBILE CARRIER MAY APPLY) text
( )
Mobile Phone

Receipt/Invoice Date: / /2016

Month Day

I had my new set of 4 eligible Bridgestone tires mounted on the following vehicle:

Year Make Model

ELIGIBLE TIRES: (Please indicate set of 4 tires purchased. Run flat versions of all eligible tires accepted.) Dueler LTH (VALID ONLY AT DISCOUNT TIRE)

DriveGuard Dueler H/L Alenza Potenza S04 Pole Position Potenza RE760 Sport
Ecopia EP422 Dueler H/L Alenza Plus Potenza RE050 Potenza RE960AS Pole Position RFT
Ecopia EP422 Plus Dueler A/T Revo 2 Potenza RE050A Potenza RE970AS Pole Position
Turanza Serenity Plus Dueler HP Sport Potenza RE11 Potenza RE97AS
Dueler H/L Ecopia 422 Dueler HP Sport AS Potenza RE71R Blizzak W965
Blizzak DM-V1 Blizzak LM 001 Blizzak LM-60 Blizzak WS60
Blizzak DM-V2 Blizzak LM-25 4x4 Blizzak LM-80 EVO Blizzak WS70
Blizzak DM-Z3 Blizzak LM-32 Blizzak LM-500 Blizzak WS80

OFFER EXCLUDES COSTCO AND GM DEALER PURCHASES. Reward will be fulfilled with a Bridgestone Visa Prepaid Card by mail. Limit 1 reward per each set of 4 tires purchased, limit 2 rewards per
household, customer or address. Visa prepaid card may be used everywhere Visa debit cards are accepted. Certain limitations apply. See Cardholder Agreement. Not redeemable for cash.
Please allow 1012 weeks for the receipt of the prepaid card. Visit BridgestoneRewards.com or call (800) 926-3716 to check the status of your claim after 4 weeks.

Please check the boxes that apply to you: How did you learn about this promotion (check all that apply):
This is my first time purchasing Bridgestone products. In Store Online Print Ad Other

This is my first time participating in a Bridgestone promotion. Mailer Radio TV

How many vehicles are in your household? Please provide where you purchased your Bridgestone Tires:
1 2 3 or more
Store Name
When do you next plan to purchase tires?
Store Address
6 months 1 Year 2 Years Other
City State Zip Code

BRIDGESTONE FALL PROMOTIONAL TERMS AND CONDITIONS

Limit 2 reward claims per household, customer or address. Invoice and claim form must be submitted for each eligible purchase.
1. Retail purchasers only. Offer excludes commercial, fleet and group purchases, employee changeovers, and warranty replacement purchases. Valid in the U.S. only. Void in PR and where
prohibited. Must be 18 or over. No special orders or rain checks. Claim form required. Cannot be combined with any other offer.
2. Customer information collected herein is solely used by Bridgestone Americas Tire Operations, LLC (Bridgestone) for internal marketing purposes and for the administration of Offer,
and to contact the consumer if we have express consent. Bridgestone and its agencies are not responsible for (a) late, lost, altered, forged, illegible/garbled, inaccessible, corrupted,
defective, postage due or misdirected submissions regardless of cause, or (b) technological problems/malfunctions/failures of any kind. All decisions of Bridgestone are final.
3. Bridgestone Visa Prepaid Card issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC. The Prepaid Card is given to you as a reward or
gift and no consideration, value or money has been paid by you for the card. No cash access or recurring payments. Card valid for up to six months, unused funds forfeit at midnight EST
the last day of the month of the valid thru date. Card terms and conditions apply; see BridgestoneRewards.com/CardTerms. All trademarks and brand names belong to their respective
owners. Use of these trademarks and brand names do not represent endorsement by or association with this card program. All rights reserved.
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