Fleet Claim Form

FLEET ACCOUNT INFORMATION

COMPANY NAME FLEET IDENTIFICATION NUMBER (FIN) LESSEE NAME (for leasing companies only)

STREET ADDRESS CITY STATE ZIP CODE

DELIVERY DEALERSHIP INFORMATION

DEALERSHIP NAME DEALER CODE PHONE EMAIL

STREET ADDRESS CITY STATE ZIP CODE

AUTHORIZED DEALER SIGNATURE DATE PRINT NAME AND TITLE

Email/Scan completed form to: Fleet@MazdaUSA.com or Fax to: (949) 272-4663

APPROVED

NOT APPROVED

Fleet Claim Form

Fleet Program MFP3

SALES INFORMATION

VEHICLE IDENTIFICATION NUMBER

(Only list vehicles(s) sold or leased to the above account.)

P.O. NUMBER MODEL

DELIVERY DATE

COURTESY

DELIVERY

PAYMENT

INCENTIVES

TOTAL $

Month Day Year Description Amount

TOTAL PAYMENTS TO DEALER $

FOR MNAO USE ONLY

MAZDA FLEET OPERATIONS AUTHORIZED SIGNATURE DATE COMMENTS

ALL PAYMENTS ARE SUBJECT TO THE MAZDA FLEET PROGRAM GENERAL TERMS AND CONDITIONS, INCLUDING THOSE ON THE SECOND PAGE OF THIS FORM

The undersigned Dealer certiﬁes that the vehicles listed below are eligible for the MAZDA Fleet Program beneﬁts claimed herein.

DEALER UNDERSTANDS THIS CLAIM IS SUBJECT TO AUDIT BY MAZDA.

12560-548 FC-MFP3, Rev. 03/2019

0.00

I. DEFINITIONS

“MAZDA Fleet Program” means any program which MAZDA may publish from time to time to any of

its Dealers and which MAZDA designates as a MAZDA Fleet Program. MAZDA in its discretion may

publish and maintain in eect more than one MAZDA Fleet Program at any one time. As used in any

MAZDA Fleet Program, the following terms shall have the following meanings.

“MAZDA” means MAZDA North American Operations.

“Dealer” means an authorized MAZDA dealer who elects to participate in the MAZDA Fleet Program

by submitting an Order or claim to MAZDA under the MAZDA Fleet Program.

“Eligible Fleet Account” means a Leasing Company, Commercial Fleet, Daily Rental Company or

governmental agency which has purchased and registered (for use in its business or for lease to others)

not less than ﬁve motor vehicles during the twelve (12) month period or calendar year preceding the

date that the Program Period starts, or any other entity designated by MAZDA from time to time in any

MAZDA Fleet Program as an Eligible Fleet Account.

“Eligible Fleet Vehicle” means a new MAZDA brand motor vehicle of the type identiﬁed by MAZDA

in the MAZDA Fleet program, which is sold by a Dealer and ﬁrst registered or Titled to an Eligible

Fleet Account in the United States of America in accordance with the provisions of the MAZDA Fleet

Program. No vehicle shall be an Eligible Fleet Vehicle which has been used as a demonstrator or service

loaner, or as otherwise determined by MAZDA. No vehicle leased by an Eligible Fleet Account to its

customer shall be an Eligible Fleet Vehicle unless such lease is determined by MAZDA to be a bona-

ﬁde lease for a term of not less than twelve (12) months.

“Commercial Fleet” means a company which purchases Eligible Fleet Vehicles for use by its employees

in the conduct of the company’s business, or as otherwise determined by MAZDA.

“Daily Rental Company” means a company which regularly engages in the rental of motor vehicles to

the general public on a daily, weekly or monthly basis and which purchases Eligible Fleet Vehicles for

the purpose of such rentals, or as otherwise determined by MAZDA.

“Leasing Company” means a company which regularly engages in the long term lease of motor

vehicles to its customers and which purchases Eligible Fleet Vehicles for the purpose of such leases, or

as otherwise determined by customers and which purchases Eligible Fleet Vehicles for the purpose of

such leases, or as otherwise determined by MAZDA.

“Dealer Aliated Leasing Company” means a Leasing Company to which Eligible Vehicles are sold by

a Dealer and which is owned or controlled by Dealer, or any of the immediate or ultimate shareholders

or any of their relatives, whether directly or indirectly, as determined by MAZDA.

II. APPROVAL OF ELIGIBLE FLEET VEHICLES

On or before any Order is placed by a Dealer for the sale of Eligible Fleet Vehicles, an application must be

submitted to MAZDA, using MAZDA’s Application for Fleet Account Eligibility Form (Form MFP1) or such other

form or document required by MAZDA. MAZDA reserves the right to approve or disapprove any account as an

Eligible Fleet Account. Approval by MAZDA in no way constitutes a determination or approval by MAZDA of the

creditworthiness of the Eligible Fleet Account, and Dealer shall not rely on any such approval for such purpose.

Upon approval, MAZDA will issue the Eligible Fleet Account a unique MAZDA ﬂeet identiﬁcation number or

conﬁrm the account’s number using the most recent publication of the R.L. Polk Fleet Name List or other similar

publication selected by Mazda. Such identiﬁcation number must be speciﬁed on all Orders, Claims and other

communications by Dealer to MAZDA regarding the Eligible Fleet Account.

III. VEHICLEINSERVICE REQUIREMENT

To help assure that all sales of Eligible Fleet Vehicles to Eligible Fleet Accounts are bona-ﬁde transactions,

each such Eligible Fleet Vehicle must be (i) placed in use (or leased for use) within thirty (30) days after delivery to

the Eligible Fleet Account and (ii) kept in ﬂeet service and not resold by the Eligible Fleet Account for the following

periods of time: six (6) months if the Eligible Fleet Account is a Daily Rental Company, six (6) months if the Eligible

Fleet Account is a Commercial Fleet, and six (6) months if the Eligible Fleet Account is a Leasing Company.

IV. OTHER

No Agency. MAZDA Fleet Programs do not make either MAZDA or Dealer the agent, partner or legal

representative of the other for any purpose. Dealer speciﬁcally acknowledges that Dealer’s submission

of an application for an Eligible Fleet Account or placing of an Order under a Mazda Fleet Program will

not obligate MAZDA in any manner except as speciﬁed in the MAZDA Fleet Program.

No Implied Waivers. The failure of MAZDA to require any performance by Dealer under a MAZDA

Fleet Program shall not aect the right of MAZDA to require such performance at any time thereafter

under such MAZDA Fleet Program or any other MAZDA Fleet Program.

Taxes. MAZDA shall have no liability for any taxes of any kind arising from the sale of a motor vehicle

under any MAZDA Fleet Program, or the lease of a motor vehicle sold thereunder.

Interpretation and Modiﬁcation. Whenever MAZDA is required or permitted under any MAZDA

Fleet Program to make any determination or interpretation, the decision of MAZDA in making such

determination or interpretation shall be ﬁnal and binding upon all Dealers concerned. MAZDA at

any time may cancel, amend, modify, expand or revoke any MAZDA Fleet Program or any provision

thereof, provided that it provides Dealers prior written notice thereof.