"CUSTOMER NAME _____________________________________________________________
VIN# ____________________________________________ DATE _____________________
I CERTIFY THAT: (CHECK ONE)
______ THE GENUINE SUBARU CARPETED FLOOR MATS RECEIVED WITH THIS VEHICLE HAVE BEEN DESTROYED
AND ARE NO LONGER AVAILABLE FOR ANY USE.
______NO GENUINE SUBARU CARPETED FLOOR MATS WERE RECEIVED AT THE TIME OF VEHICLE PURCHASE.
CUSTOMER SIGNATURE _________________________________________________________
DEALER WITNESS _____________________________________________________________"
