Drive Rebates® Enrollment Form

 
  Instructions:
   (1) Type the requested information into the form.
   (2) Print the completed form.
   (3) Sign the form.
   (4) Mail it to the following address:

   Citi Driver's Edge Redemption Center
   PO Box 6097,
   Sioux Falls, SD 57117-6097
 
 
 
 
 
     Check here if you are enrolling in the Drive Rebates® program for the first time.
     Check here if you are already enrolled in the Drive Rebates® feature and are changing the registered vehicle.

About the primary cardmember *
Name
Address    
City    
State    
Zip    
Email Address (optional)**    
Citi Driver's Edge Options Account Number    
Type of vehicle    
Other    
Brand of Vehicle    
Other    
Year of Vehicle    
Model of Vehicle    
Vehicle Identification No.(VIN)***    
Current Odometer Reading on Vehicle    
When are you planning on purchasing your next vehicle?    
 
I certify that the vehicle identified above is owned or leased by me and that the number of miles is accurate as of the date that I complete this form and agree to the Terms and Conditions of this program listed below.
 
Primary Cardmember Signature   Date  

Mail to:
Citi Driver's Edge Redemption Center
PO Box 6097,
Sioux Falls, SD 57117-6097


* Citibank reserves the right to request additional information prior to enrollment.
** If you provide an email address, we may use it to contact you about your account. We may also use your email address to send you information about products and services you might find useful.
*** VIN must be valid for request to be processed.



Printable Terms and Conditions