Questionnaire
Seat Belt ExtenderWe have received your request for a Seat Belt Extension. In order to respond, specific information must be supplied regarding the individual and vehicle involved.
Please answer the following questions:
1. Write in the Vehicle Identification Number (VIN) of the car or cars in which you need the longer belt. The VIN is located on the left front top surface of the instrument panel and is visible from the outside of the car. Note the VIN below.
2. Part number, if shown, Manufacturer's Name and Model Number that appears on the label of the seat belt assembly along with the color of the webbing. Colored extenders for past model vehicles are furnished on an "as material available basis" only. If webbing of the color designated for a past model vehicle is not available, the extension will be furnished in black.
The label (Figure 2) which is stitched to the webbing is located either slightly above where the webbing attaches to the floor (near the door) or in the retractor. The label on the webbing stowed inside the retractor can be found by fully extracting the webbing from the retractor. Note information below:
3. Measurement in Inches
Place the seat in the position that it is in when you drive or ride in the car. With you sitting in the seat make sure that the buckle is extended as far through the seat as possible. This may be done by giving the buckle a hard pull. With the buckle resting against your hip, measure from the lap area directly below the navel to the front edge of the buckle (Figure 3) and note dimension below.
*NOTE: If measurement is 12 inches (304.8mm) or less, a seat belt extender is not available.
With this information, we can supply a seat belt extender tailored for your personal use that will maintain the proper seat belt orientation.
Body of letter to be included with the Seat Belt Extender
Enclosed Seat Belt Extender was made according to the information you supplied on the Questionnaire. This extender will allow you to use your seat belt properly.
We must stress that this seat belt extender was custom made for you and should be used only by you and only in the particular vehicle for which it was made. As noted on the label affixed to the seat belt extender, it should not be used in any other vehicle or by other persons because it will not fit others in a way that affords the protection that belt restraints are designed to offer. There is always a risk of serious injury in a crash, and seat belt restraints usually reduce that risk. However, the risk would not be reduced (it may even be made worse) for people other than you using the extender, or for you if you use it in another vehicle.
4. Customer Information
Name:
Address:
City, State:
Customer Signature:
5. Dealer Information
Name:
Address:
City, State:
Dealer Parts Code:
Parts Manager's Signature
Mail completed questionnaire to:
Warehousing and Distribution Division of GM 6060 West Bristol Road Flint, MI 48554
Attention: National Order Department