Help Make a Difference - Tell Us Your Story!

This is step 1 in the process needed to recall the Gen3.
Step 1 - Step 2 - Step 3

Thank you for taking the time to tell us about your experience with a Gen3 or other safety belt. By adding your voice, you will help to make seat belts safer. You will receive confirmation via email of receipt of your information. Please contact us at info@unsafebelts.com if you have any questions.

First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Home Phone:	Ext.
Work Phone:	Ext.
Fax Number:
Email:

Vehicle Information

Vehicle Year:
Vehicle Make:
Other:
Vehicle Model:

Did your experience include:

accident	no accident
sudden stop	no sudden stop
sharp turn	no sharp turn
child safety seat belt involved
How many times?

Have you reported this to NHTSA?	yes no
Have you reported this to the Dealer?	yes no
Have you reported this to Chrysler?	yes no

Describe what happened (optional):

Enroll me automatically as a member of the "Coalition to Recall the Gen3" and "gift" me my free one-year membership in the Center for Auto Safety, including my free copies of "Lemon Times" and "The Car Book 2003"!