Address (No P.O. Boxes)*

Phone* E-mail*

City* State Zip*

Retailer Purchased From Date Purchased*

First Name* Last Name*

How did you hear about Rugged Ridge, Omix-ADA or Alloy USA?

Vehicle Year* Vehicle Make* Vehicle Model*

Would you recommend our products?Yes No

*ALL FIELDS ARE REQUIRED

Why did you choose our products?Brand Style/Look WarrantyPrice Quality Rebate Other

GET UP TO $250 CASH

BACK!

Just Buy a Qualifying Rugged Ridge® Wheel Sets or Spacer Pairs To Recieve Up To $250.(Qualifying Wheel Sets Recieve a $250 Rebate, Spacer Pairs Recieve a $50 Rebate.)

See reverse side for qualifying parts. Cannot be combined with other offers.

Terms & Conditions:Wheels & Spacers Cash Rebate Offer is good on purchases made at authorized retailers between May 1, 2018 through May 31, 2018. You must submit the rebate form within 60 days of the original purchase date. All requests must be postmarked no later than 60 days from retail invoice/receipt date. P.O. boxes will not be accepted. Maximum rebate for any one consumer and address is the greater of $2,000 or 10 rebate requests during this 12 month promotion period, whichever occurs first. All Omix-ADA family brand products must be on 1 invoice per rebate submission. Consumers are allowed up to 10 rebates per household during the promotion dates. Allow up to 8-10 weeks after rebate end date for processing of each rebate claim. Original label containing the UPC code (found on the outside of the product’s package) and an original receipt or invoice is required. Rebate checks will be paid in U.S. Dollars. Cash redemption value is 1/100 of 1 cent. Keep copies of all materials submitted; originals will not be returned. Omix-ADA, Inc. is not responsible for lost, late, damaged, misdirected, incomplete, incorrect, or illegible requests. Offer is limited time only. False information or misrepresentation disqualifies this claim and violators may be prosecuted. Offer void where prohibited, taxed or restricted by law. Omix-ADA, Inc. reserves the right to modify or withdraw this promotion at any time. Rebate offer valid to residents of the lower 48 continental US states, Alaska, Hawaii, District of Columbia and Canadian provinces only.

*For Canadian consumers, the checks will be issued in US Dollars using an average of a rolling conversion rate between US and Canadian currency

Completed Form Original UPC(s) Receipt/Invoice OMIX-ADA, INC. ATTN: REBATES460 HORIZON DR., STE 400SUWANEE, GA 30024

Mailed To:

WHEELS &WHEEL SPACERS MAY 1ST - 31ST, 2018

SKU Item Rebate 15201.02 Wheel Spacers, 1.25 Inch, 5x4.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.03 Wheel Spacers, 1.25 Inch, 5x5.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.04 Wheel Adapters, 1.25 Inch, 5x4.5 to 5x5.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.05 Wheel Spacers, 1.5 inch, 5x5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.06 Wheel Adapters, 1.375 Inch, 5x5 to 5x4.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.07 Wheel Adapters, 1.375 Inch, 5x5 to 5x5.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.08 Wheel Spacers, 1.5 Inch, 5x4.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.09 Wheel Spacers, 1.5 Inch, 5x5.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.10 Wheel Adapters, 1.375 Inch, 5x4.5 to 5x5.5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.11 Wheel Adapters, 1.375 Inch, 5x4.5 to 5x5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.12 Wheel Spacers, 1.25 Inch, Black; 96-13 Toyota Truck and SUV $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.13 Wheel Spacers, 1.00 Inch, Black; 86-05 Suzuki Models $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.14 Wheel Spacers, 1.25 Inch, Black, 5x5; 99-04 Jeep Grand Cherokee $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.15 Wheel Adapters, 1.25 Inch, 5x4.5 to 5x5 $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.16 Wheel Spacers, 1.25 Inch, 5x150mm; 07-17 Toyota Tundra $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.17 Wheel Spacers, 1.75-In; 05-17 Jeep Commander/Grand Cherokee/Wrangler $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.18 Wheel Spacer, Black, 1.25"; 06-17 Ford Ranger $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.19 Wheel Spacer, Black, 1 Inch/25 mm; 10-17 VW Amarok $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15201.20 Wheel Spacers, Black, 1.25 inch; 15-17 Renegade $50.00 Get $50 back when you buy two pairs of Rugged Ridge wheel spacers or adaptors in May15301.01 XHD Wheel, 17x9, Black Satin; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15301.20 XHD Wheel, 17x9, Chrome; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15301.30 XHD Wheel, 17x9, Gun Metal; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15301.40 XHD Wheel, 17x9, Silver; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15301.60 XHD Wheel, Black Satin, 17x8.5; 07-18 JK/JKU $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15301.61 XHD Wheel, Gun Metal, 17x8.5; 07-18 JK/JKU $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15302.01 Drakon Wheel, 17x9, Black Satin; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15302.02 Drakon Wheel, 18x9, Black Satin; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15302.30 Drakon Wheel, 17x9, Gun Metal; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15302.31 Drakon Wheel, 18x9, Gun Metal; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15303.90 Jesse Spade Wheel, 17x9, Black Satin; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15303.92 Jesse Spade Wheel, 17x9, Satin Gun Metal; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15304.01 Drakon Wheel, 20x9, Black Satin; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15304.30 Drakon Wheel, 20x9, Gun Metal; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15305.01 XHD Wheel, 18x9, Black Satin; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15305.30 XHD Wheel, 18x9, Gun Metal; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15305.40 XHD Wheel, 18x9, Silver; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15306.01 XHD Wheel, 20x9, Black Satin; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15306.02 XHD Wheel, 20x9, Gun Metal; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15306.03 XHD Wheel, 20x9, Silver; 07-18 Jeep Wrangler JK/JL $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15307.01 5 Spoke, Blk, Aluminum Wheel, 17x8; 14-18 Jeep Renegade BU $150.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15307.02 TREK 8 Spoke, Black, 17x8, Aluminum Wheel; 14-18 Renegade BU $150.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15311.01 XHD Wheel/Center Cap, 17x9, Black Satin; 07-18 Jeep Wrangler JK $250.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.01 D Window Wheel, 15x8, Black, 5x4.5 $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.02 D Window Wheel, 15x10, Black, 5x4.5 $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.10 D Window Wheel, 15x8, Black, 5x5.5 $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.70 D Window Wheel, 17x9, Black, 5x5 $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.76 Steel Wheel, Trail Runner Classic, 17x9; 07-18 Jeep Wrangler JK/JL $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May15500.78 Steel Wheel, Trail Runner Classic, W/Center Cap, 17x9; 07-18 Wrangler $100.00 Get up to $250 back when you buy a set of 5 Rugged Ridge wheels in May

Parts eligible for rebate: