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your name
address
cIty
state ZIp
10-dIGIt phone
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If you provide your email address we will notify you when your claim has been received via email.
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(www.geappliances.com/privacy/privacy_policy.htm).
Offer void where prohibited, taxed, or restricted by law. Not transferable or
redeemable for cash. Fraudulent submission of form could result in federal
prosecution for mail fraud under the U.S. Mail Fraud Statutes (18 USC Section
1341 and 1342). This form must be included with your claim. Omission of sales
receipt or any other required infor mation will delay processing. Please allow eight
to ten weeks from the time the form is received for delivery of the prepaid Visa
card. If not received after ten weeks, call 1-866-319-9259, Monday-Friday: 9:00
AM - 9:00 PM EST; Saturday-Sunday: 9:00 AM - 5:00 PM EST.
Cards are issued by Citibank, N.A. pursuant to a license from Visa U.S.A. Inc. and
managed by Citi Prepaid Services. Cards will not have cash access and can be used
everywhere Visa debit cards are accepted. This card is a Visa prepaid card. Each
time you use the card the amount of the transaction will be deducted from the
amount of your available balance. Terms and Conditions apply to the card.
Subject to applicable law, a monthly maintenance fee of $3 (USD) applies, but is
waived for the first six months after the card is issued. No additional fees will be
assessed once the card balance reaches zero. Cards can be used at merchants that
accept Visa debit cards. GE reserves the right to substitute a check of equal value
in lieu of a Visa prepaid card at its sole discretion.
I/we hereby understand and accept the above requirements for receipt of the
prepaid Visa card and I/we represent that all information provided on this
document is accurate and not falsified.
Your Signature _________________________________________________________________________________________ Date ______________________
35430-GE Pub. No. 3-D0036 PC84335
Serial Number Model Number
prevIous wall oven:
Serial Number
new Ge applIances wall oven:
Modification Cost
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Manufactured under trademark license.