foreigntire



*Consumer Name:
Consumer Address: City: State: zip:
*Consumer Telephone: - -
*Consumer E-mail address:

Tire Brand: Please set forth the number of each brand tire you have and the DOT numbers of each
	DOT Number(s):
Westlake:
Compass:
YKS:



Size: Set forth the number of each size tire replaced

Size	Model
LT235/75R-15 :	CR861:	CR857:

LT235/85R-16 :	CR860:	CR861: CR857:

LT245/75R-16 :	CR860:	CR861: CR857:

LT265/75R-16 :	CR860:	CR861: CR857:

LT31X10.5R-15:	CR857:	CR861:

Please tell us where you purchased the tires that are being replaced

Date you purchased the tires(yyyy/mm/dd): Select Date
Dealer name:
Dealer address: City: State: zip:

Please fill out this questionnaire completely. Give the completed questionnaire to the dealer replacing the tires. DEALER-attach each consumer questionnaire to the dealer reimbursement form and certification.
PRINT this page before submitting this questionnaire. Give the completed questionnaire to the dealer replacing the tires.


* Fields are required.