GM Fast-Cash - Register

Independent Body Shop Program Profile

	Please use the form below to create your program profile. It's very important that we have accurate information about you and your shop so we can process your rebates properly. This profile will be used to process and validate your rebate claims. Any incorrect or missing information may invalidate or delay your eligible rebates. If you need assistance, please call Program Headquarters at 1-877-348-1822 and ask for a Fast-Cash Coordinator. (Fields in red are required.)

	Please enter the requested information below and click "CREATE PROFILE".
	Create Password:		(minimum 6 characters)
	Confirm Password:

	Shop Owner/Manager Name:
	Title:
	E-mail Address:
			GM may e-mail me about this program and other promotional offers: Yes No
	Shop Name:
	Shop Address:

	Shop City:
	Shop State, Zip Code:
	Shop Telephone Number:
	Shop Fax Number:

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