This is from Canada so change with title, etc as needed ...



This is from Canada so change with title, etc as needed - printed on company letterhead as follows:

*** A FEE OF $20.00 APPLIES ***

KEY CODE AUTHORIZATION

I,______________________________________________, DO HEREBY

AUTHORIZE "dealership name" TO OBTAIN KEY CODES

FOR THIS VEHICLE FROM "manufacturer":

VIN:______________________________________________________

YEAR:____________________________________________________

MAKE:____________________________________________________

MODEL:___________________________________________________

I UNDERSTAND THAT MY SIGNATURE ABSOLVES

"dealership name" OF ANY LIABILITY OR RESPONSIBILITY FOR THE DISCLOSURE OF THIS INFORMATION.

"dealership name" DOES NOT GUARANTEE THE ACCURACY OF THIS CODE AS WE CAN ONLY ACCESS THIS INFORMATION FROM THE "manufacturer name" DATABASE, OF WHICH "dealership name" HAS NO CONTROL.

CUSTOMER SIGNATURE:______________________________________

*** THE REGISTERED OWNER MUST BE THE PERSON REQUESTING THIS INFORMATION. A COPY OF THE VEHICLE REGISTRATION AND THE REGISTERED OWNERS DRIVERS LICENSE MUST BE ATTACHED TO THIS REQUEST. IF THIS IS A COMPANY VEHICLE, A REQUEST MUST BE FAXED ON COMPANY LETTERHEAD TO "dealership name" ASSIGNING THE PERSON PICKING THE CODE UP. THIS PERSON MUST PROVIDE THEIR DRIVERS LICENSE AS PROOF OF IDENTITY.

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