Mail in this claim form to receive your rebate.† by eat9932


									                                Mail in this claim form to receive your rebate.†
                 To qualify, you must purchase a set of four Michelin high-performance tires                                                     ®

                  from a participating Michelin retailer between April 17 and May 20, 2006.

Please print legibly

First name*                                                                                                   Last name*


City*                                                                                                         Province*

Postal code*                                       -                                                          Daytime telephone (                             )                           -

E-mail address

Name of retailer                                                                                                           Date of purchase
                                                                                                                           day - month - year                        -                   -

City                                                                                                   Province
† The federal and provincial tax will be calculated on the selling price before the rebate. / * Required information

1. Is this the first time you have purchased Michelin® tires?                                             3. Did this promotion influence your selection of Michelin® tires versus a competitive product?   Yes     No
       Yes     No
                                                                                                          4. Which listed attribute(s) most influenced your decision to buy Michelin® tires? (Please check up to three)
2. How did you find out about this promotion?                                                                  Quality product Safety/security Driving exhilaration Reputation
     Radio     Television   In store    Newspaper                      Internet       Friend/family            Rebate offer Recommended by sales person

   I do not authorize Michelin to send me information concerning contests, promotions and new products.
Michelin knows how important it is to protect your personal information. Please consult our privacy policy at
                                                                                                                      ELIGIBLE TIRES:
                                                                                                                       Pilot® Sport Cup                 Pilot® Primacy™                             4x4 Synchrone®
                                                                                                                       Pilot® Sport PS2™                Pilot® HX MXM®                              4x4 Diamaris®
                                                                                                                       Pilot® Sport                     Pilot® HX MXM4®                             Pilot® LTX™
                                                                                                                       Pilot® Sport A/S                 Pilot® MXX3™                                Latitude® Tour HP
                                                                                                                       Pilot® Exalto® A/S               Energy® MXV4® Plus/S8                       4x4 XPC™
                                                                                                                       Pilot® Exalto® PE2™              Cross Terrain® SUV H-rated                  Pilot® Preceda
                                                                                                                       Pilot® XGT® V4                   LTX™ M/S H-rated                            Energy® E3A
                                                                                                                       Pilot® XGT® Z4                   LTX™ A/S H-rated

                                         Please send me the following rebate:                                         Rebate claims must be received by July 3, 2006,
                                                $100 rebate on a set of 4 ZR-rated tires                              at the following address:
                                                $75 rebate on a set of 4 V-rated tires                                Michelin Coupon Redemption Centre,
                                                $60 rebate on a set of 4 H-rated tires                                219 8th Avenue, Ile Perrot, Qc, J7V 4T2

     NOTE: To obtain your rebate please send in the original claim form and a copy of the detailed invoice* clearly indicating the purchase of four Michelin® high-performance tires
    (purchased between April 17 and May 20, 2006).
   Ask your participating authorized Michelin® retailer or visit for details. This offer cannot be combined with any other Michelin® promotion or program. Retail sales only. Offer valid only in Canada
 from April 17 to May 20, 2006. Purchases outside these dates will not be honoured. Please allow 4-6 weeks to receive your rebate.
*Estimates, work orders or quotations are not acceptable as proof of purchase. For any information regarding the rebate, please call 1-866-425-1331 or visit

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