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Request for a Test Drive PERSONAL INFORMATION        First Name Mr. Ms. Mrs. Dr.   Last Name   Age Select Age 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65   Email     Mobile Number     City Select City Jeddah Abha Khamis Mushait Jizan Najran Wadi Ad Dwaser Al Hassa Al Raka Al Khobar Dammam Dhahran Qatif Jubail Khafji Hafra Al Batin   VEHICLE INFORMATION Please indicate the General Motors vehicle you would like to test drive Vehicle Select Vehicle Acadia Aveo Camero Camero (LS3, V8, 6.2L) - Jeddah Only) Caprice Corvette Z06 (LS3, V8, 6.2L) - Jeddah only Corvette ZR1 (LS3, V8, 6.2L) - Jeddah only Cruze Epica Malibu Optra Tahoe Traverse Yukon   Test Drive Location Select Location Jeddah Abha Khamis Mushait Jizan Najran Wadi Ad Dwaser Al Hassa Al Raka Al Khobar Dammam Dhahran Quatif Jubail Safaniyah Khafji Hafra Al Batin   How would you like us to contact you Phone Email Expected next vehicle purchase Select one 1 to 3 Months 3 to 6 Months More than 6 Months Not sure if you own or drive a GM vehicle, please specify Car Make & Model Select one Chevy - Spark Chevy - Aveo Chevy - Optra Chevy - Cruze Chevy - Epica Chevy - Lumina Chevy - Caprice Chevy - Camero Chevy - Corvette Chevy - Captiva Chevy - Trailblazer Chevy - Traverse Chevy - Traverse Chevy - Suburban Chevy - Colorado Chevy - Avalanche GMC - Terrain GMC - Acadia GMC - Envoy GMC - Yukon GMC - Yukon XL GMC - Savana GMC - Sierra Model Year Select Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 Universal Motors Agencies will store this information for marketing purposes including tele-marketing and Internet activity. If you prefer this not to happen please un-check this box:

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