LOST COMBINATION FORM
| I, _____________________________________, being duly sworn, say I am the owner of the | |
| (Print Name) | |
Master Lock® padlock with the serial number ____________________________. |
|
| (Serial Number) | |
| *NOTE: You must attach a photocopy of the back of the padlock with this form. | |
My lock combination should be sent to: |
|
| ________________________________________ | |
| (Name) | |
| ________________________________________ | |
| (Address) | |
| ________________________________________ | |
| (Address) | |
| ________________________________________ | |
| (E-mail Address) | |
| ________________________________________ | |
| (Signature) | |
| STATE OF __________________________________ | |
| COUNTY OF __________________________________ | |
| Sworn to and subscribed before me | |
| this _______ day of _______, 200__ | |
| My commission expires on: | |
| ________________________________________ | |
| ________________________________________ | |
| (Notary Public) | |