PRODUCT DEFECT NOTICE

Date:_______________________________

To:_________________________________

Dear________________________________:

Notice is hereby provided that we have purchased a product manufactured, distributed, or sold by you and described as:

You are advised of a product defect or warranty claim. In support of same we provide the following information:

1. Date of Purchase:

2. Nature of Defect:

3. Injuries or Damage:

4. Item Purchased From:

This is provided to give you earliest notice of said claim. I request that you or your representative contact me as soon as possible.

Sincerely,

_______________________________________
Name

_______________________________________
Address

_______________________________________
City, State, Zip

_______________________________________
Telephone Number

CERTIFIED MAIL, Return Receipt Requested
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