[Dealer's Letterhead]

Authorization to Deactivate an Air Bag

I, __________________________________,  the owner of the following vehicle:

Make:
Model:
Year:
VIN:
State of Registration:
Registration Number:
Owner's Present Address
Owner's Present Telephone Numbers
-Home
-Business

acknowledge and understand that:

(1) NHTSA in its letter to me, dated states that it will not enforce against the dealer that portion of Federal Law which prohibits deactivation of the air bag, or air bags;

(2) A deactivated air bag will not deploy and thus will provide neither life-saving, nor injury reducing,protection in the event of a motor vehicle collision. NHTSA, in its letter to me, explained fully the added safety provided by air bags and notwithstanding that explanation, I still desire to have my air bag, or air bags,deactivated;

(3) I will allow the dealer to attach Warning Labels to my vehicle and I will ensure that those labels remain in place as long as the air bag, or air bags, remains deactivated.

(4) At some time in the future, NHTSA may adopt a change in its regulations and allow deactivation of the air bag without their approval. If that regulation is adopted as a final rule, I may be provided additional labels by either NHTSA, or the dealer, and I agree to affix those labels to my vehicle in accordance with the instructions provided and will ensure that they remain in place as long as the air bag, or air bags, remain deactivated.

(5) By authorizing the deactivation of an air bag in my vehicle, I waive any claim, or cause of action,that I may have against the dealer and/or Chrysler Corporation because the air bag has been deactivated.

Dated:__________________________

Owner's Signature______________________________

Owner's Signature_______________________________

Revised September 4, 1997
 


Thanks to Bob Bergevin and Barry Drodge for supplying this TSB information

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This page was edited on: May 3, 2004