ACDelco TechConnect

Registration Intent form

Language Preference
Owner First Name
Owner Last Name
Independent Service Centre (ISC) Shop Name

Business Address*
City
Province
Postal Code
Website Address
Phone Number
Company Twitter Page
Company Facebook Page
Email
Verify Email
Promotion Code (if applicable)

Alternative Contact/Manager (if different)
First Name
Last Name

Shipping Address (if different than above)

Street Address
City
Province
Postal Code

*Must be a physical address.

Retail Service Support Program (RSSP) Affiliation

Please provide your program affiliation information. (Franchise or Corporate Head Office information)

Head Office Company Name
Mailing Address
City
Province
Postal Code

Select one of the following Programs:

ACDelco PSC member in the Retail Service Support Program – qualify for all ACDelco PSC benefits and Rewards and Includes a Monthly Fee/Charge
ACDelco RSSP - No charge and qualify for online training, Roadside Assistance and Labour Reimbursement

OPTIONAL - Cancel account from another ACDelco Program

The business is currently enrolled in another ACDelco Program and wishes to cancel to register for the ACDelco PSC RSSP or RSSP. By selecting one of these options, you agree to cancel from your current ACDelco program membership, as of this date, and proceed registering for the ACDelco RSSP.

Cancel from the following program:

ACDelco PSC RSSP Rewards Program

As part of your ACDelco PSC RSSP membership, you can earn rewards for your monthly purchases through your reporting ACDelco distributor(s). You will also have the opportunity to earn bonus rewards throughout the year with exclusive program member promotions. Any qualifying rewards will be paid to you each month and paid based on the payment method you pick during registration. You can receive your monthly rewards in one of two ways: A Reloadable ACDelco PSC Visa Rewards card or a rebate processed through each reporting ACDelco distributor.

Note: Changes to ACDelco PSC RSSP rewards option are done once annually on a calendar year, and may not be changed outside of this time period.

The choice between these options is up to the account and should depend on the needs of the business. ACDelco PSC Rewards Points are made by ACDelco to the Business and it will be the sole responsibility of the Business Owner to report any taxable benefit conferred on any individual under the program that may be required under the Income Tax Act and to issue the requisite T4 and T4A information slips.

If you currently have another business registered on the ACDelco PSC RSSP program and you would like to have the different membership put on the same rewards card, please ensure to notify us by contacting the Info-Line at 1-800-263-3526 after submitting the form. This applies to the Visa Rewards payment only and is not applicable to a rebate.

The undersigned Independent Service Centre (ISC) has read the terms of enrolment of the ACDelco Professional Service Centre member in the Retail Service Support Program and wishes to enrol in the ACDelco PSC Rewards Program. ISC will begin earning rewards on eligible purchases starting the month of enrolment in accordance with the ACDelco Professional Service Centre member in the Retail Service Support Program terms and conditions. The ISC understands that it must be enrolled in the ACDelco Professional Service Centre member in the Retail Service Support Program to be eligible to participate in the ACDelco PSC Rewards Program.

YES Enroll in the ACDelco Professional Service Centre Rewards Program - Earn points on ACDelco purchases
No, I am not interested in rewards program at this time. (Selecting No will mean no points/rebates are awarded to the owner/cardholder)

REWARDS SELECTION

I would like to receive and be paid my ACDelco RSSP Rewards via:

A prepaid Reloadable ACDelco PSC Visa Rewards card*
A rebate to my repair facility, processed through my reporting ACDelco Distributor(s).

*Activation Requirement for the Reloadable ACDelco Visa card - Please note selecting a prepaid reloadable Visa card will require identity verification in order to activate the card and secure the funds. This includes completing a profile within a secure site at MyPrepaidCenter and confirming details on fund use, occupation and uploading a selfie and photo of a government issues ID to complete your identity verification. By selecting payment by a reloadable Visa Rewards Card you understand this administrative requirement.

REWARDS CONTACT

Please note that the following information is required for the prepaid reloadable ACDelco PSC RSSP Visa Rewards card and the distributor rebate. A secondary rewards cardholder should only be provided if you selected the reloadable Visa card and want to add second cardholder (rewards are split between two cards).

1. Primary Rewards Contact:

First Name
Last Name
Email
We recommend using your personal email address as confidential rewards information will be sent to and accessible.
Rewards Address (if different than above)
City
Province
Postal Code

2. Secondary Rewards Contact (Optional – splits rewards equally each month when Visa card is selected):

First Name
Last Name
Email
We recommend using your personal email address as confidential rewards information will be sent to and accessible.
Address (if different than above)
City
Province
Postal Code

ACDelco reserves the right to cancel the ACDelco PSC Rewards Program at any time without prior notice.

Facility

Total number of service bays
Number of Employees
Number of years in operation

Supplier Information

Sponsoring Distributor Name

Name
City

Other Distributor Supplier Names:

Name
City
Name
City
Name
City

ACDelco Distributor Supplier

Salesperson
First Name
Last Name

Do you own more than one shop? You are required to attain a membership for each shop and pay the full membership fee for each individually addressed shop if you would like to earn rewards for each business’ purchases. Only shops officially registered and approved for the program will qualify for program benefits and rewards regardless if the shops are under the same corporation or owned by the same individual. This includes participation in program promotions.

Terms and Conditions

Membership in the ACDelco Professional Service Centre member in the Retail Service Support Program (the "Program") and the earning and redemption of ACDelco PSC Rewards are subject to the ACDelco PSC member in RSSP Guidelines (the "Guidelines") as they may be amended from time to time by General Motors Canada Company ("GM Canada" or "ACDelco"). The current version of the Guidelines are attached hereto. These terms and conditions are referred to herein as the "Agreement".
Without limiting the generality of section 1 above:
1. The Guidelines set out the current Program structure and benefits;
2. ISC must pay all monthly fees as set out in the Guidelines;
3. ISC must continue to satisfy the Program eligibility requirements;
4. ISC is solely responsible for the ACDelco PSC Visa Rewards card; ACDelco is not responsible for lost or stolen cards, if selected.
During the term of its enrolment in the Program, ISC is licensed to use the ACDelco trade-mark ("the Mark") in connection with the conduct of its related automotive service operations at the location specified on the first page of this Registration Form provided that:
1. ISC adheres to the standards governing the quality of products and services provided in association with the Mark that are set from time to time by the owner of the Mark, and communicated to ISC by ACDelco;
2. ISC may use the Mark only in the form and manner, and only with the appropriate legends, prescribed from time to time by the owner of the Mark, and communicated to ISC by ACDelco;
3. ISC does nothing to jeopardize the validity of the Mark or the goodwill attaching hereto;
4. ISC uses the Mark only in association with products and services covered by the Canadian trade-mark registration for the Mark, as the case may be, and where the registration for the Mark covers products, ISC may use the Mark only in association with products purchased directly or indirectly from ACDelco in and for use and sale in Canada;
5. ISC shall not use the Mark or any other trade-mark of General Motors LLC or any of its subsidiaries or affiliates (collectively "General Motors"), or any part thereof, without the prior written consent of General Motors or its designee;
6. ISC shall have no right to initiate or prosecute any legal actions or other proceedings, of any nature, involving the Mark; only General Motors and/or GM Canada shall have such right;
7. Upon termination of this Agreement for any reason, ISC shall immediately cease any and all use of the Mark hereunder and shall discontinue the provision of products and services in association with the Mark and shall return to ACDelco all materials bearing the Mark;
8. ISC further agrees to immediately discontinue the use of the Mark and the "Professional Service Centre", "PSC", Retail Service Support Program” and “RSSP” names upon the written request of ACDelco.
ACDelco reserves the right to change, modify, reject application or cancel membership to the Program at any time for any reason without notice. In addition, ACDelco shall have the right to terminate ISC's membership in the Program in the event of ISC's breach of any of these Terms and Conditions or the then current Program Guidelines.
By clicking the check box here ISC represents and warrants that the above mentioned business is not currently operating under or in affiliation with a General Motors Dealership.
ISC will defend and indemnify and hold GM Canada harmless from any loss, damage, liability, claim, demand, suit and expense (including legal fees) which may be incurred by GM Canada or its officers, directors, affiliates, subsidiaries, parent companies, employees or agents as the result of or in connection with ISC's operation of its automotive service operations or a breach of ISC's obligations or representations under this Agreement or the Guidelines.
This Agreement shall be governed by and construed and enforced in accordance with the laws of the province in which the ISC has its principal place of business (as set out on the first page of this ACDelco PSC member in the Retail Service Support Program Registration Form).
The provisions of this Agreement and the Guidelines are severable, and if any part is found to be unenforceable, the enforceability of the remaining provisions shall remain fully valid and enforceable.
This Agreement and the Guidelines (as amended from time to time by ACDelco) constitutes the entire agreement between ISC and ACDelco with respect to the Program. The provisions of this Agreement supersede all prior and contemporaneous agreements, communications, representations, and understandings of the parties relating to the subject matter hereof.
All notices given under this Agreement shall be delivered in writing by facsimile or by reputable overnight courier addressed to the other party at the addresses appearing on the first page of this Agreement or such other address as a party may designate in writing to the other party hereto. Notice shall be deemed given upon receipt.
ISC may not assign its rights or obligations under this Agreement, either in whole or in part, without the prior written consent of ACDelco.
The parties acknowledge that ISC is and shall remain an independent contractor, and its personnel are not employees or agents of ACDelco for any purposes assumes responsibility for the acts of its employees and agents.

Facility

Total number of service bays
Number of Employees
Number of years in operation

Supplier Information

Sponsoring Distributor Name

Name
City

Other Distributor Supplier Names:

Name
City
Name
City
Name
City

Training Web Site Access

Please list all technician names that should receive access to the training web site. An email address is required for the training web site registration.

Full Name	Email	Position	Cell Phone
1.
2.
3.
4.
5.
6.

ACDelco Distributor Supplier

Salesperson
First Name
Last Name

Terms and Conditions

Membership in the ACDelco Retail Service Support Program (the "Program") is subject to the ACDelco RSSP Guidelines (the "Guidelines") as they may be amended from time to time by General Motors of Canada Limited ("GMCL" or "ACDelco"). The current version of the Guidelines are attached hereto. These terms and conditions are referred to herein as the "Agreement".
Without limiting the generality of section 1 above:
1. The Guidelines set out the current Program structure and benefits;
2. ISC must continue to satisfy the Program eligibility requirements;
During the term of its enrolment in the Program, ISC is licensed to use the ACDelco trade-mark ("the Mark") in connection with the conduct of its related automotive service operations at the location specified on the first page of this Registration Form provided that:
1. ISC adheres to the standards governing the quality of products and services provided in association with the Mark that are set from time to time by the owner of the Mark, and communicated to ISC by ACDelco;
2. ISC may use the Mark only in the form and manner, and only with the appropriate legends, prescribed from time to time by the owner of the Mark, and communicated to ISC by ACDelco;
3. ISC does nothing to jeopardize the validity of the Mark or the goodwill attaching hereto;
4. ISC uses the Mark only in association with products and services covered by the Canadian trade-mark registration for the Mark, as the case may be, and where the registration for the Mark covers products, ISC may use the Mark only in association with products purchased directly or indirectly from ACDelco in and for use and sale in Canada;
5. ISC shall not use the Mark or any other trade-mark of General Motors LLC or any of its subsidiaries or affiliates (collectively "General Motors"), or any part thereof, without the prior written consent of General Motors or its designee;
6. ISC shall have no right to initiate or prosecute any legal actions or other proceedings, of any nature, involving the Mark; only General Motors and/or GMCL shall have such right;
7. Upon termination of this Agreement for any reason, ISC shall immediately cease any and all use of the Mark hereunder and shall discontinue the provision of products and services in association with the Mark and shall return to ACDelco all materials bearing the Mark;
8. ISC further agrees to immediately discontinue the use of the Mark and the “Retail Service Support Program” and “RSSP” names upon the written request of ACDelco.
ACDelco reserves the right to change, modify, reject application or cancel membership to the Program at any time for any reason without notice. In addition, ACDelco shall have the right to terminate ISC's membership in the Program in the event of ISC's breach of any of these Terms and Conditions or the then current Program Guidelines.
By clicking the check box here ISC represents and warrants that the above mentioned business is not currently operating under or in affiliation with a General Motors Dealership.
ISC will defend and indemnify and hold GMCL harmless from any loss, damage, liability, claim, demand, suit and expense (including legal fees) which may be incurred by GMCL or its officers, directors, affiliates, subsidiaries, parent companies, employees or agents as the result of or in connection with ISC's operation of its automotive service operations or a breach of ISC's obligations or representations under this Agreement or the Guidelines.
This Agreement shall be governed by and construed and enforced in accordance with the laws of the province in which the ISC has its principal place of business (as set out on the first page of this ACDelco Retail Service Support Program Registration Form).
The provisions of this Agreement and the Guidelines are severable, and if any part is found to be unenforceable, the enforceability of the remaining provisions shall remain fully valid and enforceable.
This Agreement and the Guidelines (as amended from time to time by ACDelco) constitutes the entire agreement between ISC and ACDelco with respect to the Program. The provisions of this Agreement supersede all prior and contemporaneous agreements, communications, representations, and understandings of the parties relating to the subject matter hereof.
All notices given under this Agreement shall be delivered in writing by facsimile or by reputable overnight courier addressed to the other party at the addresses appearing on the first page of this Agreement or such other address as a party may designate in writing to the other party hereto. Notice shall be deemed given upon receipt.
ISC may not assign its rights or obligations under this Agreement, either in whole or in part, without the prior written consent of ACDelco.
The parties acknowledge that ISC is and shall remain an independent contractor, and its personnel are not employees or agents of ACDelco for any purposes assumes responsibility for the acts of its employees and agents.

Security Code

Registration Intent form

Shipping Address (if different than above)

Retail Service Support Program (RSSP) Affiliation

OPTIONAL - Cancel account from another ACDelco Program

ACDelco PSC RSSP Rewards Program

REWARDS SELECTION

REWARDS CONTACT

Facility

Supplier Information

ACDelco Distributor Supplier

Terms and Conditions

Facility

Supplier Information

Training Web Site Access

ACDelco Distributor Supplier

Terms and Conditions

Agreement

Agreement