2022 CHAMPION REBATE SUBMISSION FORM

2022 CHAMPION REBATE SUBMISSION FORM
Must send proof of purchase of $100 or more in Champion products to qualify for Rebate.
Full Name*

PrefixFirst NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Verify E-mail*
example@example.com
Race Team Website Link
Facebook page name/link
Twitter handle/link
Instagram handle/link
YouTube Channel/link
Please send proof of purchase

Cancelof
Where did you buy Champion products from?
YesNoMaybe (Connected with a potential distributor)
Should be Empty: