MSR MB Information Request Form Test
Information Request Form
Corporate Account Number (CAN): 020034
2000 Westchester Avenue
Purchase, NY 10577
To redeem the Reserved Living & Giving offer from Mercedes-Benz:
- Fill out the form fields below online, check "I AGREE" at the bottom and submit the form online (please note that this form must be submitted via this website; your local dealer will not be able to process a printed version of this Enrollment Form). You will receive an email from Mercedes-Benz within two business days (to the email address you provide when filling out the requested information, please be sure to check your spam folder) with a form attached which you must print out and present to the dealership at the time of the purchase or lease.
- Please contact the toll-free hotline at 1-866-628-7232 or visit the program's website at www.fleet.mbusa.com for additional program information. Note: All supporting documentation is subject to third party verification.
"*" indicates required fields
Please hit SUBMIT only once; it may take a few seconds to process.
TERMS & CONDITIONS
Only One (1) control number per individual per calendar year, and the control number is valid until one year from issue date.
Morgan Stanley Smith Barney LLC shall not be responsible for, and does not represent, products or product providers. The manufacturer’s warranty applies to all applicable merchandise offered. The actual merchandise available through the program may vary from pictures and descriptions that have been made available to you. All merchandise is subject to availability.