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2023 TECHNOLOGY REBATE PAYMENT REQUEST FORM

Important rebate details:

  • Rebates are available for all Cenex® branded marketers.
  • Only one rebate per dispenser applies, unless otherwise noted.
  • Equipment must be purchased through, and installed by, an authorized equipment distributor.
  • Equipment must be purchased by August 31, 2023, and installed by December 31, 2023.
  • Required documentation to be submitted with this form includes invoice with detailed description of purchased equipment and final installation invoice.
  • Only one rebate option may be used per dispenser unless otherwise noted.
  • *May be combined with other 2023 dispenser rebate categories.

Dispensers

Eligible Equipment

Technology Option

Available Rebate

Qty

Total

New EMV capable fuel dispenser(s)

$3,000 per dispenser
$18,000 max per site

$
$
$
$
$
$
$

EMV hardware for existing dispenser(s)

$1,500 per dispenser
$9,000 max per site

$
$
$
$
$
$
$

Dispenser connectivity equipment to enable outdoor EMV communications in existing dispensers

Dispenser connectivity equipment to enable outdoor
EMV communications in existing dispensers

$1,500 per dispenser
$9,000 max per site

$
$
$
$
$
$
$

Contactless (NFC) card readers*

Additional Option (may be combined with other dispenser rebates)

$500 per dispenser
$3,000 max per site

$
$
$
$
$
$
$

In-Store/back room connectivity equipment to enable outdoor EMV communications*

Additional Option (may be combined with other dispenser rebates)

$1,000 max per site

$
$
$
$
$
$

TOTAL:

Point-of-Sale

Table Option 1

Drop files here or

Max file 100MB size per form. Larger file sizes take longer to upload. Acceptable file formats include: .pdf,.jpg,.gif,.doc,.docx,.xls,.xlsx,.mov,.avi,.mp4,.mp3.

Please do not submit the form or close the window until files are fully uploaded which is indicated by a green checkmark next to the file name. For questions or issues, please contact Refined.FuelsMarketing@chsinc.com.

Table Option 2

I acknowledge that I have reviewed and understand the Cenex Privacy Notice which describes how CHS will use and protect my personal information.

Category - Point-Of-Sale

Dealer agrees to the Terms of the Program, together with all provisions set forth herein, effective as of the date on this form.

Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

CHS supported Point-Of-Sale

Option 1 - New Point-Of-Sale

$2,500
Limit 1 per site

$
$

Self-Checkout for CHS supported Point-Of-Sale System

Option 2 - Self-Checkout

$2,500
Limit 1 per site

$
$

EMV capable PIN pad(s) for use in-store with Point-Of-Sale or Self-Checkout unit

EMV capable PIN pad(s) for use in-store
with Point-Of-Sale or Self-Checkout unit

Additional Option (may be combined with other POS rebate options)

$650 per PIN pad
$2,600 max per site

$
$
$
$
$
$
$

TOTAL:

Table Option 2

Pick Your Category(s)

Not sure of your options? Look at the Table for help.

Dispenser Options

Additional Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

New EMV capable fuel dispenser(s)

$3,000 per dispenser
$18,000 max per site

Additional Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

EMV hardware for existing dispenser(s)

$1,500 per dispenser
$9,000 max per site

Additional Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

Dispenser connectivity equipment to enable outdoor EMV communications in existing dispensers

$1,500 per dispenser
$9,000 max per site

Additional Option (may be combined with other dispenser rebates)

Contactless (NFC) card readers*

$500 per dispenser
$3,000 max per site

Additional Option (may be combined with other dispenser rebates)

In-Store/back room connectivity equipment to enable outdoor EMV communications*

$1,000 max per site

Point-Of-Sale Options

Additional Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

CHS supported Point-Of-Sale

$2,500 Limit 1 per site

Additional Technology Option

Eligible Equipment

Available Rebate

Quantity

Total

Self-Checkout for CHS supported Point-Of-Sale System

$2,500 Limit 1 per site

Additional Option (may be combined with other POS rebate options)

EMV capable PIN pad(s) for use in-store with Point-Of-Sale or Self-Checkout unit

$650 per PIN pad
$2,600 max per site

TOTAL:

  • Only one rebate option may be used per dispenser unless otherwise noted.
  • *May be combined with other 2023 dispenser rebate categories.

Submit payment request form and supporting documentation to: cenex.projects@chsinc.com or fax to 866-683-0173.