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Home|dealer-forms

To ensure a prompt and accurate assessment of the complaint, all parts of this form must be fully completed by both the dealer and user.

It is also required that both dealer & user sign the respective parts of the form. Failure to do so will result in delays in processing and possibly an inappropriate conclusion. 

It is important when returning tube type tyres to also return the tube (and flap). 

NAME & FULL ADDRESS OF DEALER (1/4) 

DETAILS OF TIRE, TUBE OR FLAP (2/4)

Tire sidewall explanation



Tire 1

Tire 2

Tire 3

Tire 4

Vehicle details (3/4)

Name & full address of user (4/4)

(If the applicant is not the User of the product, please enter both the User’s name and the name of the contact person handling this application on their behalf 

USER’ S DECLARATION 

  1. I/We certify that the product referred to above is my/our property and was fitted to my/our vehicle of which details are given above.
  2. I/We consider the product has not given satisfactory service whilst on my/our vehicle and request you arrange examination by the manufacturer.
  3. I/We declare that the above mentioned tyre/tube caused no damage to vehicles, property or injuries to people and hence no consequential claim will be made related to the tyre/tube detailed on this form.
  4. I/We declare the details given above are correct to the best of my/our knowledge.
  5. I/we agree that my/our personal data set out in this Form may be retained by the Dealer in its records and be passed on to the Manufacturer of the product (and/or its relevant affiliate) which may hold and process my/our information in order to deal with this application on the terms of its privacy made available on the manufacturer's website. 

Cooper Tire & Rubber Company Europe

Bath Road
Melksham
Wiltshire
SN12 8AA
Tel: +44 (0)1225 703101