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ORIGINAL OWNER/TIRE INSTALLATION INFORMATION
Date of Purchase: ____________________________________
Owner Name: ________________________________________
Address: ____________________________________________
City: ________________________________________________
State: ________________ Zip Code:____________________
Phone No.: __________________________________________
Vehicle Year/Make/Model: ____________________________
Odometer Reading: __________________________________
Tire Size: ____________________________________________
Recommended Tire Pressure Front:__________________PSI
Recommended Tire Pressure Rear: __________________PSI
DOT No: ______________________________________Tire #1:
______________________________________________Tire #2:
______________________________________________Tire #3:
______________________________________________Tire #4:
______________________________________________Tire #5:
______________________________________________Tire #6:
To be completed at time of purchase
TIRE REMOVAL INFORMATION
Odometer reading Date Retailer Retailer
when tires removed: Removed: Name: Signature: