MARINE CO-OP ADVERTISING CLAIM FORM

DEALER #: DEALER NAME: Claim No:

Claim Date:
Phone No:
Contact Name:
Please provide dealer information. Must include dealer number. SUZUKI USE ONLY
DO NOT WRITE IN SHADED AREAS

Suzuki Amt.
Item Dates of Ads, Radio Of
Name of Pubication, Show, Radio, Etc. Total Amount of Bill Portion
No. Schedules, T.V. Events, Etc. Reimbursement
of Ad (%)

7
DEALER SIGNATURE TOTAL $ AMOUNT
SUBMITTED Ź
TOTAL AMOUNT DATE APPROVED BY
APPROVED
FOR SUZUKI USE ONLY - COMMENTS
1
2
3
4
5
6
7
REQUIRED DOCUMENTATION FOR RADIO: FOR BILLBOARDS:
*Refer to your Dealer Program binder for details. Ƒ Notarized Script. Ƒ Copy of paid invoice from posting company
□ Copy of paid invoice from indicating posting dates and net cost.
FOR NEWSPAPER/MAGAZINE: station showing net cost of time, including any Ƒ Copy of signed contract.
□
Copy of paid invoice from paper discount. Ƒ photograph of billboard in place.
showing net cost.(including any Ƒ Affidavit (supplied by radio station showing
discount) of space. broadcoast dates & times)
□
Full-page tear sheet showing newspape/rmagazine name
and date of publication.

FOR TV/CABLE: FOR BOAT SHOWS: FOR YELLOW PAGES:

□
Copy of paid invoice from Ƒ Copy of space contract Ƒ Original, full page tear sheet
station showing net cost of time, including any discount. Ƒ Copy of paid invoice Ƒ Copy of contract showing the monthly and
□
Notarized affidavit/script (supplied by TV station) showing broadcast dates & Ƒ Photos of entire space and products yearly amount and directory name
times Ƒ Overhead diagram of show layout indicating Ƒ Copy of paid invoice/phone bill
□
Video tape of spot. total number of boats and toatal number of Suzuki
outboards

THIS CLAIM FORM MUST BE SUBMITTED WITH THE REQUIRED DOCUMENTATION WITHIN 45 DAYS OF
THE ADVERTISING DATE TO QUALIFY FOR REIMBURSEMENT
MAIL THIS FORM WITH REQUIRED DOCUMENTATION TO:
Suzuki Marine Co-op - c/o Advertising Checking Bureau - PO Box 52118, Phoenix, AZ 85072-2118
(602) 438-2320 - Fax (602) 438-4837