Crash Data Form

Please complete the Crash Data Reset form below; submit your details, then print your Crash Data Reset form and send it along with your Airbag ECU to:

Electrotech,
5300 Lakeside
Cheadle Royal Business Park
Cheadle
SK8 3GP

Crash Data Reset Form

Name:

Email:

Landline Telephone:

Mobile Telephone:

Address Lane 1:

Address Line 2:

County:

Post Code:

Make:

Model:

Year of manufacture:

Airbag ECU Manufacturer:

Airbag ECU number:

Any Additional Information:

Chosen method of payment: *
BACS TransferPayment over TelephoneCheque with parcel made payable to “Electrotech”

* Payment will not be required until repair is complete and ready for dispatch.