_______________________________________________________________________________________First Name Last Name

_______________________________________________________________________________________Mailing Address

_______________________________________________________________________________________City Province Postal Code

_______________________________________________________________________________________

Email Address (REQUIRED FOR COMMUNICATION)

(______) _________________________________ Invoice Date: ____/_____/2012Mobile Phone Day Month

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I had my new set of 4 eligible Firestone I purchased these 4 tires mounted on the following vehicle: tires for personal use:

_____________________________________________________ ______________________________Year Make Model Tire model purchased on receipt

I have read and complied with all the TERMS AND CONDITIONS. Enclosed is my store-identified original final paid invoice indicating an eligible tire purchase, proof of mounting, and this original claim form. I hereby confirm that all information herein is valid and correct and consent to the collection by Bridgestone Canada Inc. of the personal information disclosed herein for the purposes described.

X _________________________________________________________________________PURCHASER’S SIGNATURE REQUIRED

Firestone Winterforce Mail-In Promotion

$50 Firestone Prepaid MasterCard®

Purchase between: October 9 – December 2, 2012.Submit this request with a postmark date NO LATER than January 2, 2013.

OFFER FST1004

Thank you for choosing Firestone tires. Please see below for terms and conditions of offer.

OFFER EXCLUDES ALL OTHER FIRESTONE TIRES AND COSTCO PURCHASES. Promotion will be fulfilled with a Firestone Prepaid MasterCard. Card value of $50 is per each set of 4 eligible tires. Not redeemable for cash. Please allow 10 to 12 weeks for receipt of the card.Visit www.firestonerewards.com to check the status of your prepaid card claim or to contact us.

OFFICIAL CLAIM FORM

ORIGINAL FINAL PAID INVOICE must be submitted with this claim form.

ELIGIBLE TIRES: Purchase of a set of 4 eligible tires from a participating Canadian Firestone Retailer’s inventoryis required.

Please indicate below which tires were purchased.

Winterforce

Winterforce UV

Winterforce LT

Please Print (Card will be issued in the name on this form)

FIRESTONE WINTERFORCE MAIL-IN PROMOTION TERMS AND CONDITIONS1. Enclose your store-identified, dated, ORIGINAL final paid invoice(s), with your name, dealer name, date of purchase showing eligible tire purchase, price paid and mounting with this completed claim form. Circle the tire purchase on your receipt. If more than one Prepaid MasterCard is requested, documentation MUST be submitted for eacheligible purchase. PHOTOCOPIES WILL NOT BE ACCEPTED.2. Name on claim form and on invoice(s) MUST be the same. Additional claims for same customer or household must include additional claim form(s) and additional original invoice(s) showing purchase of additional set(s) of 4 eligible tires for different vehicle(s). If a company name appears on invoice(s), please provide the first and last name of the authorized Card user.3. Offer valid in Canada and only to persons of the age of majority in their province of residence.4. Invoices and submissions that are altered, forged, illegible, incomplete, or defaced in any way are invalid and will automatically be deemed ineligible. 5. Bridgestone Canada Inc. does not share, sell, or otherwise distribute customer information to third parties. The information collected herein is solely used by Bridgestone for marketing purposes and for the administration of the program. Please visit www.firestonetire.ca to view our privacy policy.

6. Offer applies only to retail customers and is limited to two purchases per customer, receipt, address or household. Offer excludes commercial, fleet and group purchases, employee changeovers and mileage warranty claims.7. Customers that wish to have their original receipt returned to them must include this request in their envelope with the original submission on a 3˝ x 5˝ index card stating, “Return of original receipt requested.” Requests received at a later time will not be honored.8. Neither Bridgestone Canada Inc. nor Firestone Program Headquarters are responsible for late, lost, illegible or misdirected mail.9. Please keep a copy of materials mailed for future reference as originals become the property of Bridgestone Canada Inc. and will not be returned to the customer.10. This card is issued by Peoples Trust Company pursuant to license by MasterCard International. MasterCard is a registered trademark of MasterCard International. Cards are issued in connection with a loyalty, award or promotion program. Card issued in the name submitted on claim form and is not transferable; card cannot be issued to minors. Card does not have cash access and can be used at stores where MasterCard is accepted. Country restrictions apply and are subject to

change. The Card can be used at virtually any store that welcomes MasterCard. For questions about this card, contact 1-855-209-8384. Card terms, conditions, and limitations apply; see www.firestonerewards.com for details.11. All decisions made by Bridgestone Canada Inc. and Firestone Program Headquarters are final. For inquiries after 4 weeks, contact our toll-free number: 1-866-433-3009.

MAIL NECESSARY DOCUMENTATION (Include this form and original invoice) POSTMARKED NO LATER THAN JANUARY 2, 2013 TO:

FIRESTONE TIRE PROMOTIONFST10043000 BOUL DES LAURENTIDES, SUITE 12-166LAVAL, QC H7K 3G5

Promotion will be fulfilled with aFirestone Prepaid MasterCard.