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EXHIBIT 3 <br />0 <br />SANTA ANA RESIDENT VIP REBATE FORM <br />VEHICLE IDENTIFICATION ELIGIBLE NEW MODEL# RETAIL DELIVERY DATE <br />NUMBER <br />CUSTOMER INFORMATION FOR VALIDATION. <br />CUSTOMER LAST NAME FIRST, M.I. TELEPHONE NUMBER <br />STREET ADDRESS CITY, STATE ZIP CODE <br />❑ Address has been verified as City of Santa Ana resident <br />CUSTOMER SIGNATURE <br />17_\I4 <br />SALESMANAGER NAME (PLEASE PRINT) DEALERSHIP NAME DATE <br />SALESMANAGER SIGNATURE <br />DATE <br />THIS COMPLETED FORM MUST BE FORWARDED TO THE CITY OF SANTA ANA WITH THE VEHICLE SALES DOCUMENTS. BY <br />SIGNING THE ABOVE DOCUMENT, THE DEALER IS VERIFYING THAT THE RESIDENT LIVES IN THE CITY OF SANTA ANA AND <br />QUALIFIES FOR THE REBATE. <br />75B-18 <br />DEALERSHIP NAME <br />Purchase Amount/Rebate Amount <br />Initial below: <br />I, the customer and Santa Ana resident, have applied the Santa Ana Resident's <br />Rebate towards the purchase of my vehicle. Therefore, I have assigned the cash <br />payment directly to the dealer. I release the City of Santa Ana from any further <br />claim or obligation for payment to me for this vehicle. <br />I, the customer, give the dealership named above permission to share this <br />form, the final sales contract and a copy of my driver's license to the City of <br />Santa Ana to process the rebate. <br />CUSTOMER SIGNATURE <br />17_\I4 <br />SALESMANAGER NAME (PLEASE PRINT) DEALERSHIP NAME DATE <br />SALESMANAGER SIGNATURE <br />DATE <br />THIS COMPLETED FORM MUST BE FORWARDED TO THE CITY OF SANTA ANA WITH THE VEHICLE SALES DOCUMENTS. BY <br />SIGNING THE ABOVE DOCUMENT, THE DEALER IS VERIFYING THAT THE RESIDENT LIVES IN THE CITY OF SANTA ANA AND <br />QUALIFIES FOR THE REBATE. <br />75B-18 <br />