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Get Fiberlock Form 330 2013

401224-6 K W FiberLock Head Gasket Block Repair Refund Request Form Double Your Money Back Guarantee In the event that the purchaser uses K W FIBERLOCK Head Gasket Block Repair in accordance with instructions and the purchaser s vehicle is not repaired CRC Industries Inc. will refund to the purchaser double the purchase price of 401224-6 K W FIBERLOCK Head Gasket Block Repair. This guarantee is null and void in the event that the purchaser did not comply with the explicit directions for use of this product. Refund will not exceed 91. 98. One refund per household individual organization or group transaction* Except as set forth above CRC Industries Inc* makes no warranty expressed or implied with respect to K W FIBERLOCK Head Gasket Block Repiar including warranties of merchantability or fitness for a purpose. The refund of purchase price set forth above is the purchaser s sole remedy and CRC Industries Inc* shall not be liable for any incidental or consequential damage including without limitation cost of mechanical repairs. Please include 1. ORIGINAL sales receipt copies NOT permitted showing purchase date and product number/description* 2. A LETTER detailing vehicle s initial symptoms how the product was used and resulting outcome. Please complete this form and mail it along with the above listed materials to Attn Auto Rebate Dept. K W FIBERLOCK REFUND 885 Louis Drive Warminster PA 18974 Name City State Product purchase date Vehicle year Mileage Engine size Modifications Have you used this product before Address Zip Phone Vehicle make/model Vehicle Identification Number VIN If so were you satisfied If so please supply brand names Did they work Each form is good for one 1 refund on one 1 bottle of product only. One 1 refund per vehicle. Please allow 10-12 weeks for refund. Declaration I the undersigned declare that I am the owner of the vehicle referred to in this claim and that the product s directions for use were followed exactly and without deviation* I also declare that after using K W FIBERLOCK Head Gasket Block Repair as directed the product did not repair my vehicle s head gasket freeze plugs engine block cooling system cylinder head radiator or heater core as specified on the product packaging. Signed Date Limitations COMPLETED CLAIM FORM MUST BE RETURNED TO ADDRESS LISTED ABOVE WITHIN NINETY DAYS OF PURCHASE DATE* a* b. c* d. e. Limited to one claim per vehicle. Limit one refund per household individual organization or group transaction* Void if necessary documents are not sent or are illegible. Void if claim form is not complete. Void where taxed or prohibited by law. Any deliberate attempt to obtain a double-money back payment by falsification of any information or documentation may constitute fraud and consequently initiate an investigation* Form 330 Revision 1 Revision Date 07/22/13. This guarantee is null and void in the event that the purchaser did not comply with the explicit directions for use of this product. Refund will not exceed 91. 98. One refund per household individual organization or group transaction* Except as set forth above CRC Industries Inc* makes no warranty expressed or implied with respect to K W FIBERLOCK Head Gasket Block Repiar including warranties of merchantability or fitness for a purpose. .

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