2016 POLARIS ATV and ACE NEW RACER REIMBURSEMENT PROGRAM
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1 2016 POLARIS ATV and ACE NEW RACER REIMBURSEMENT PROGRAM Thank you for your interest in racing Polaris ATVs and ACE. This program was created to provide first-time racers the ability to collect a Reimbursement on their new, racing ATV or ACE purchase. Reimbursements $1000 back on qualifying ATVs Qualifying ATVs: Scrambler 850, Scrambler XP 1000 EPS $2000 back on qualifying ACEs Qualifying ATVs: ACE 570 SP, ACE 900 SP Eligibility Reimbursement is paid at the end of the respective race season as long as the racer raced in more than half of the series races. Reimbursements will be paid only to registered Polaris owners and only to racers who have executed the release and waiver set forth below. Sales registration for the unit must be on file with Polaris Industries Inc. (Polaris) prior to the racing. All Polaris logos must be predominantly displayed on the vehicle. Reimbursement forms will only be issued to racers with a valid U.S. mailing address. Reimbursements will only be given for qualifying, new units that were purchased at a Polaris factory authorized dealership. Factory-sponsored teams and/or racers are ineligible for Polaris Reimbursement Program. Units must be new 2015 or 2016 units purchased after Sept. 1, 2015 to qualify for a Reimbursement. Polaris is limiting this Reimbursement to the first 25 qualified submissions. Reimbursement Claim 1. Polaris Reimbursement Program Period: January 1 December 31, Reimbursement will be only paid after: > Polaris receives the completed Reimbursement Claim Form > Confirmation that the vehicle was raced in more than half a qualifying series races and that the racer has competed on a qualified Polaris model. 3. Falsification of claim forms will result in future disqualification from any Reimbursement programs. Polaris Reimbursement Program qualification and details are subject to change without notice. 4. In all matters concerning the interpretation of the Polaris Reimbursement Program, the decision of Polaris is final. 5. Polaris has the right to cancel or modify this program anytime, without prior notice. ATV and ACE Race Series 1. The following race series will be eligible for the Polaris Reimbursement Program: > GNCC Grand National Cross Country Series > WORCS World Off Road Championship Series > BITD Best in the Desert > SCORE International Reimbursement Payment 1. Reimbursements will be paid via check at the end of the qualifying race season. 2. Reimbursement request must be claimed for reimbursement by December 1, Reimbursements are limited to the first 25 qualified submissions.
2 2016 ATV and ACE RACING DISCOUNT PROGRAM Thank you for your interest in racing Polaris ATVs and ACE. This program was created to provide racers the ability to receive a discount on their new, racing ATV or ACE purchase. Qualifying ATVs Unit Scrambler 850 Discounted Purchase Price (Plus tax and applicable fees) $7,800 Scrambler XP 1000 EPS $10,900 The following race series will be eligible for the Polaris Discount Program: > GNCC Grand National Cross Country Series Qualifying ACE Unit Discounted Purchase Price (Plus tax and applicable fees) ACE 570 SP $8,200 ACE 900 SP $9,400 > WORCS World Off Road Championship Series > BITD Best in the Desert > SCORE International *U.S. pricing only Eligibility Discount is available to those racers who raced at least half of the races of a qualifying racing series in 2015 and intend to race full 2016 season. Racers must provide proof of races raced. Racer qualifies for one discounted unit. Discount or unit is not transferrable. Discount is available only to racers who have executed the release and waiver set forth below. Sales registration for the unit must be on file with Polaris Industries Inc. (Polaris) prior to racing. Discount will only be available to racers with a valid U.S. mailing address. Reimbursements will only be given for qualifying, new units that were purchased through Polaris Factory-sponsored teams and/or racers are ineligible for Polaris Discount Program. Units must be 2016 units and purchased through Polaris directly. Polaris is limiting this Discount to the first 250 qualified submissions. All Polaris logos must be predominantly displayed on the vehicle. Discount Claim Polaris Discount Program Period: Dec. 1, 2015-May 1, Discount only available after: > Polaris receives the completed Discount Claim Form > Proof of racer racing in at least half of qualifying races 2016 season is submitted or new racer provides proof of racing a 2016 series and references. > Polaris will contact the racer for payment (cashier s check) which must be received before unit will be ordered. 3. Falsification of claim forms will result in future disqualification from any racing programs. Polaris Discount Racing Program qualification and details are subject to change without notice. 4. Polaris cannot guarantee a shipping date and this program is only available on product shipped directly from Polaris. 5. In all matters concerning the interpretation of the Polaris Discount Racing Program, the decision of Polaris is final. 6. Polaris has the right to cancel or modify this program anytime, without prior notice.
3 2016 GNCC ACE RACING INCENTIVE PROGRAM Polaris ACE is offering additional incentives for racing qualified Polaris ACE vehicles in the Grand National Cross Country (GNCC) Series. Qualifying ACE vehicles (2015 or 2016 models): ACE 570, ACE 570 SP, ACE 900 SP GNCC End of Year Prize Program Finish FIRST OVERALL from the GNCC Single Seat Classes: Win a 2017 ACE of your choice* Finish SECOND OVERALL from the GNCC Single Seat Classes: Win $5,000 in prize money* Finish THIRD OVERALL from the GNCC Single Seat Classes: Win $2,500 in prize money* *The 2016 GNCC Single Seat Classes combined must average at least six racers per race throughout the season to qualify for the End of the Year Prize Program. GNCC RACING FEE REIMBURSEMENT Polaris will reimburse up to $600 in racing fees ($100 per race raced) when half the GNCC single-seat classes are raced. GNCC RACING FEE REIMBURSEMENT Reimbursement and End of Year Prize Program is paid at the end of the respective race season pending if stipulations are met. Reimbursement and End of Year Prizes will be paid only to registered Polaris owners and only to racers who have executed the release, waiver and W9 below. Sales registration for the unit must be on file with Polaris Industries Inc. (Polaris) prior to racing. All Polaris logos must be predominately displayed on the vehicle. Both programs are only available to racers with a valid U.S. mailing address. Factory-sponsored teams and/or racers are ineligible for the programs. Units raced must be new 2015 or 2016 ACE 570, 570 SP or 900 SP units Polaris is limiting the racing fee reimbursement to the first 25 qualified submissions. REIMBURSEMENT CLAIM 1. Polaris Reimbursement Program Period: January 1 December 31, Reimbursement will be only paid after: > Polaris receives the completed Racing Programs Enrollement Form > Confirmation that the vehicle was raced in more than half a qualifying series races and that the racer has competed on a qualified ACE model. 3. Falsification of claim forms will result in future disqualification from any Reimbursement programs. Polaris Reimbursement Program qualification and details are subject to change without notice. 4. In all matters concerning the interpretation of the Polaris Reimbursement Program, the decision of Polaris is final. 5. Polaris has the right to cancel or modify this program anytime, without prior notice. REIMBURSEMENT PAYMENT 1. Reimbursements will be paid via check at the end of the GNCC race season. 2. Reimbursement request must be claimed for reimbursement by December 1, Reimbursements are limited to the first 25 qualified submissions.
4 2016 RACING FEE REIMBURSEMENT AND END OF YEAR PRIZE PROGRAM (GNCC ONLY) PLEASE PRINT > RACER INFORMATION Name: Last, First, Middle Initial Name you race under if different: Address: Race Class: Age: Telephone: Hometown: (City, State) > MINOR EXEMPTION (must be completed if racer is under 18 years of age or a minor in your state) Issue the Reimbursement Check* in the name of the following: Minor s name: Parent/Guardian name: : Address: > PRODUCT INFORMATION Model year: (circle one) 2015 / 2016 Frame Vehicle Identification Number (17 digits): > EVENT INFORMATION List GNCC Races Raced and attach proof of racing, MSO and photo of vehicle: I certify that all the information listed above is accurate, and falsification of any information will disqualify me from the Reimbursement Program now and in the future. Signature of Rider NOTE: Prior to submitting racer must have completed all sections of the form. For questions concerning the Reimbursement Program, ATV.Racing@polaris.com or send a FAX to Polaris Racing at
5 2016 ATV and ACE RACING PROGRAMS ENROLLMENT FORM PLEASE PRINT > RACER INFORMATION Name: Last, First, Middle Initial Name you race under if different: Address: Race Class: Age: Telephone: Hometown: (City, State) > MINOR EXEMPTION (must be completed if racer is under 18 years of age or a minor in your state) Issue the Reimbursement Check* in the name of the following: Minor s name: Parent/Guardian name: : / / 16 Address: > WHAT PROGRAM(S) ARE YOU ENROLLING IN Racing Discount Program (Scrambler/ACE) New Racer Reimbursement (Scrambler/ACE) GNCC Racing Fee Reimbursement (ACE only) GNCC End of the Year Prize Program (ACE only) > PRODUCT INFORMATION Model year: (circle one) Frame Vehicle Identification Number (17 digits): 2015 / 2016 Model: (circle one) Qualifying ATVs: Scrambler XP 850 EPS / Scrambler XP 1000 EPS Qualifying ACE: ACE 570 / ACE 570 SP / ACE 900 SP > EVENT INFORMATION Qualifying Series Raced: (circle one) GNCC / WORCS / BITD / SCORE List Races Raced and attach proof of racing, MSO and photo of vehicle: I certify that all the information listed above is accurate, and falsification of any information will disqualify me from the Reimbursement program now and in the future. Signature of Rider NOTE: Prior to submitting this form, racer must have completed all sections of the Enrollment Form, Release Form and IRS Form. For questions concerning the Reimbursement Program, ATV.Racing@polaris.com or send a FAX to Polaris Racing at
6 2016 ATV and ACE RELEASE FORM To be eligible for the Polaris reimbursements, racer must complete section A D of the Enrollment Form and send or FAX completed form to the address or fax number on the bottom of page 2. READ AND SIGN THE RELEASE. A parent or guardian must also sign the Parent or Guardian Consent for all riders under 18 years of age. Section C must only be completed if dealer or someone other than an immediate family member owns the ATV or SxS. Section A RELEASE, LIABILITY WAIVER, INDEMNIFICATION AND ASSUMPTION OF RISK In consideration of being considered to participate in the Polaris 2016 race programs, I, the undersigned, for myself, successors, heirs and assigns, release, waive liability, promise never to sue, and forever discharge, Polaris Industries Inc. (Polaris) and its affiliates, agents, employees, servants, officers, directors, and authorized Polaris dealers ( Released Parties ) from all claims, including but not limited to claims for negligent acts or omissions, actions or judgments I may have or claim to have against Polaris and related parties. I agree that I am responsible for all personal injuries, including death, and injuries to property, real or personal, caused by or arising out of my participation in the Polaris Contingency Program. I understand that ATV riding is inherently dangerous. I represent to Polaris that I have had sufficient experience riding ATVs and ACEs to understand all the risks involved in ATV and ACE racing. I expressly and voluntarily assume all risk of personal injury or death sustained while participating in the Program, whether or not caused by the negligence or other fault of Released Parties, or any of them, including but not limited to equipment malfunction from any cause, inadequate training or supervision, defective design of equipment or ATV race course, failure to keep safe, failure to investigate or supervise other riders, or failure to warn of potential risks. I further agree for myself, my successors, heirs and assigns to indemnify and hold the Released Parties harmless from all claims and suits for personal injuries, including death, and damages to property caused by my act or omission arising out of my participation in the Polaris Contingency Program, and from all judgments recovered and from all expensed incurred in defending said claims or suits. I am in good health and have no physical conditions that would prevent me from participating in the Polaris Contingency Program. I further agree to that without compensation, my name, as well as any photographs, pictures, slides, or movies taken of myself or made in connection with my participation in the Polaris Racing Program, or any reproduction of the same, may in any manner be used by Polaris, or by any person, corporation or association authorized by Polaris. I understand that I am giving up substantial rights by signing this document. I agree to abide by all the eligibility requirements as listed in the eligibility requirements on the previous page. I agree to use all recommended safety equipment and to abide by all warnings and safety recommendations of Polaris. I agree that I will not race while under the influence of alcohol or drugs. Signature of Rider Section B PARENTAL CONSENT, RELEASE, LIABILITY WAIVER AND INDEMNIFICATION I hereby certify that I am the parent or legal guardian of (print name), a minor ( Child ) and that I have read Section A of this Release set forth above. I understand that for my Child to participate in the Polaris Race Program, I hereby consent to my Child s participation in the Polaris Racing Program and agree on behalf of my Child, myself and my spouse to release the Released Parties and waive liability from all claims, including, but no limited to, claims for negligent act or omissions, arising from or related to my Child s participation in the Polaris Race Program. I agree that my Child and I will be bound by all for the terms listed in Section A and B of this release. I understand that there are risks (including serious bodily injury or death) associated with participating in the Polaris Race Program, and I hereby assume, on behalf of my Child, myself and my spouse, all such risks, including those detailed above. I am releasing the Released Parties from any or all claims I or my spouse may have for emotional distress or loss of consortium in the event my Child suffers bodily injury or death. I further agree, for myself, my spouse, successors, heirs and assigns, to indemnify, defend and hold the Released Parties harmless from all claims and suits for personal injuries, including death and damage to property caused by any act or omission arising out of my Child s participation in the Polaris Race Program, and from all judgments recovered and from all expenses incurred in defending said claims or suits. I understand that I am giving up substantial rights by signing this document. I further agree to that without compensation, my Child s name, as well as any photographs, pictures, slides, or movies taken of my Child or made in connection with my Child s participation in the Polaris Race Program, or any reproduction of the same, may in any manner be used by Polaris, or by any person, corporation or association authorized by Polaris. Parent Signature Print Name Section C SPONSORED RIDER AFFIDAVIT I have agreed to sponsor the rider listed above ( rider ). I am the owner of the ATV or SxS and understand that no additional person(s) other than the rider will be paid reimbursement from Polaris. Dealers sponsoring riders must have paid for the unit in full. Dealership/Owners Name Owners Address Owners Signature
7 2016 ATV and ACE IRS FORM Section D TO RECEIVE REIMBURSEMENT, RACER MUST FILL OUT THE IRS FORM W-9 BELOW. REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION SUBSTITUTE FORM W-9 PLEASE TYPE OR PRINT Name: Last, First, Middle Initial Address: City: State: Zip Code: Phone: TAXPAYER IDENTIFICATION NUMBER (TIN) ENTER SOCIAL SECURITY NUMBER BELOW: Social Security Number (SSN) CERTIFICATION SIGN HERE Under penalties of perjury, I certify that the number provided on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me.) Signature: : PURPOSE OF THIS FORM: A PERSON WHO IS REQUIRED TO FILE AN INFORMATION RETURN WITH THE IRS MUST OBTAIN YOUR CORRECT TIN TO REPORT INCOME PAID TO YOU. FURNISHING YOUR CORRECT TIN AND MAKING THE APPROPRIATE CERTIFICATION WILL PREVENT PAYMENTS FROM BEING SUBJECT TO 31% BACKUP WITHHOLDING. For office use only: Polaris Vendor # NOTE: Sections A D of the 2016 Enrollment Forms need only be completed once per year to enroll in any or all Racing Programs. For questions concerning the programs, atv.racing@polaris.com or send a FAX to Send completed Enrollment Forms Sections A-D to atv.racing@polaris.com, or FAX to All Enrollment Forms must be filled out completely (Sections A-D) to enroll in all programs. For additional information visit the Polaris Racing website at:
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