Abarth 500 2012 User Manual

FIAT Forward CareTM Acknowledgement

FFC Disclosure Form #001

This form must be Signed & Retained in the Deal Jacket

Customer Acknowledgement: The customer must initial the box below and sign. Failure to do so and include
this acknowledgement disclosure form in the deal jacket will result in a charge back of all applicable incentives on
this VIN.

FIAT Forward Care™:

Prior to purchasing the FIAT 500 bearing the VIN Number specified below, I the customer, was advised (i) that the
FIAT Forward Care™ maintenance program has been terminated, (ii) that my purchase of the FIAT 500, and
Warranty for the vehicle, would not and does not include any benefits of FIAT Forward Care™, and (iii) that the

specific benefits of the vehicle FIAT Forward Care™ maintenance program not included in my purchase are,

among other things, the following:

- Scheduled 3/36 maintenance (including wear items i.e. brake pads & rotors, clutch, wiper blades)

- First day rental and 5 day rental allowance

- Trip interruption Customer Initial

In addition, by signing and initialing this form, I understand that my Window Sticker, Warranty Materials, including the

Warranty and the Warranty Manual DVD, and/or other sales or advertising materials may reference FIAT Forward Care™

as a standard option available with all FIAT 500 models excluding Abarth. I acknowledge, however, that my purchase of
the FIAT 500, and Warranty for the vehicle, does not include FIAT Forward Care™ nor any benefits under the FIAT

Forward Care™ maintenance program. I further acknowledge that this disclosure form supersedes those publications and
other materials which make mention to the FIAT Forward Care™ program benefits.

By signing, Customer is acknowledging that he/she will not receive the benefits of FIAT Forward Care™,
including, but not limited to, the benefits specified herein.

Customer:

Print Name Signature

VIN Number: Date:

Studio Signature: Date:

This document supplements the warranties and conditions described in the vehicle’s Warranty Information book.

No other warranty coverages are altered or extended based on this supplement.