I understand that one or both airbags in this car have been replaced with an airbag cover replacement. I am completely aware that the airbag cover replacement is strictly a cosmetic device, serves no safety purpose whatsoever, and does not contain an airbag.

I will not hold the seller of this vehicle, the seller of the inserts and/or the manufacturer of the insert liable should accident, death, or injury occur.

I am responsible for informing any new owners of this fact and am responsible for all waivers to be signed stating the same information as above.


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Vehicle Make, Model, and Year


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VIN Number


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Printed Name and Signature of Seller/Date


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Printed Name and Signature of Purchaser/Date