The purpose of data collected on this website is to validate program guidelines, communicate with you about your request, facilitate any payment awarded and assess for potential duplicate and/or fraudulent submissions. As a service provider, we do not sell your information but we do share information with program owners and financial institutions.
Dealer Number
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First Name
Last Name
Primary Email Address
Home Address
Home Address 2
Home Zip/Postal Code
Home City
Home State/Province
Personal Phone
Cell Phone
Security Question
Security Answer
Social Security Number
Confirm Social Security Number
 You must click on the Terms and Conditions Link to review and check the box acknowledging your acceptance of the Terms and Conditions
 You must click on the Program Rules Link to review and check the box acknowledging your acceptance of the Program Rules

IRS Terms and Conditions

Under penalties of perjury, I certify that:

  1. I verify that the social security number I entered in the above fields is correct.
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below)

Certification Instructions. You must select item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN.

 I agree to the IRS Terms and Conditions