Laserfiche WebLink
1*40MIZIM <br />VEHICLE IDENTIFICATION ELIGIBLE NEW MODEL # RETAIL DELIVERY DATE <br />NUMBER <br />BUSINESS INFORMATION FOR VALIDATION: <br />BUSINESS NAME REPRESENTATIVE NAME TELEPHONE NUMBER <br />STREET ADDRESS CITY, STATE ZIP CODE <br />❑ Business license has been verified as City of Santa Ana business. <br />DEALERSHIP NAME I Purchase Amount/Rebate Amount <br />Initial below: I, the customer and Santa Ana business, have applied the Santa Ana Rebate towards <br />the purchase of my vehicle. Therefore, I have assigned the cash payment directly to <br />the dealer. I release the City of Santa Ana from any further claim or obligation for <br />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 business license to the City of <br />Santa Ana to process the rebate. <br />SANTA ANA BUSINESS REPRESENTATIVE SIGNATURE DATE <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 BUSINESS OPERATES IN THE CITY OF SANTA ANA AND <br />QUALIFIES FORTH E REBATE. <br />75B-19 <br />