First Name *

Last Name *

Email *

Phone Number

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Part #

Part Type *

Vehicle Make/Model/Year *

Tire Size (ex: 225/65R17) *

Number of Tires Attempting to Fill

Starting Tire Pressure (PSI) *

Desired Ending Pressure (PSI)

How Long Was the Unit Running? *

Reason for Use (Emergency Repair or Future Flat Prevention) *

Size of Puncture (if Emergency Repair)

Tire Size *

General Description of the Issue or Inquiry *

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Refill Bottle for the Slime Smart Repair Ultra Flat Tyre Repair Kit Car/Trailer (#10201-5) Instructions