Firestone (Steeltex tires)

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Defendant:
(who caused the harm?)

Firestone Tires

*Describe your complaint:
(briefly describe the damages you have suffered)

State(s) where tire purchased and/or failure occurred:

DOT Tire Number:

Year, make, model of Vehicle:

Date(s) of purchase:

Date(s) of failure(s):

If your vehicle was damaged due to the tire failure, what were your total damages?:

Did the failure cause an accident, injuries or death?:

Do you still have your Steeltex tires, or have you returned them to Firestone?:

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*Last name:

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*Zip/Postal Code:

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Firestone (Steeltex tires)