To: __________________________

________________________________

________________________________ (address)

Notice is hereby given that on ______________ (date of delivery) , I accepted the tender of _________________________ (merchandise delivered) under our contract for purchase dated ___________ (date) .

That beginning on ____________ (date) and continuing to the present date, the following defects in the above mentioned goods have become manifest: _______________________________________________________________________ (set forth defects).

_____________________________________________________________________ (Specify relief sought).

Dated: __________________

_______________________

(Signature)