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Outline for New Manufacturer Information - NHTSA

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Appendix 10 – Sample Tire Registration Form – Independent Distributors and Dealers<br />

IMPORTANT<br />

In case of a recall, we can reach you only if we have<br />

your name and address. You MUST send in this<br />

card to be on our recall list.<br />

SHADED AREAS MUST<br />

Do it today. BE FILLED IN BY SELLER<br />

CUSTOMER’S NAME (Please Print)<br />

CUSTOMER’S Address<br />

CITY STATE ZIP CODE<br />

NAME OF DEALER WHICH SOLD TIRE<br />

DEALER’S ADDRESS<br />

CITY STATE ZIP CODE<br />

QTY TIRE IDENTIFICATION NUMBERS<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║ ║<br />

62

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