SUPPLIER PFAS ATTESTATION REQUEST
(Free template from ProductSentry — productsentry.com. Fill in the brackets,
send on your letterhead or by email. No signup, no strings.)

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Date: [DATE]

To: [SUPPLIER COMPANY NAME]
Attn: [CONTACT NAME / QUALITY OR COMPLIANCE DEPARTMENT]

Re: PFAS content attestation for materials supplied to [YOUR COMPANY NAME]

Dear [CONTACT NAME],

Several US states now restrict or require reporting of per- and
polyfluoroalkyl substances (PFAS) that are intentionally added to consumer
products, including Minnesota (Minn. Stat. 116.943, reporting due
September 15, 2026), California (AB 1817), Washington, Maine, Vermont,
Rhode Island, New Hampshire and New Mexico. "Intentionally added" includes
PFAS used in finishes, coatings, treatments, membranes, inks, adhesives and
processing aids — not only listed ingredients.

To meet our obligations, we need a written attestation covering the
following materials/components you supply to us:

  [LIST MATERIALS, FABRICS, COMPONENTS, OR FINISHED GOODS — include style
  numbers, colorways or lot references where applicable]

For each item listed above, please confirm in writing:

  1. Whether PFAS (any per- or polyfluoroalkyl substance, defined as a
     substance containing at least one fully fluorinated carbon atom) is
     INTENTIONALLY ADDED to the item, at any stage — including water- or
     stain-repellent finishes (e.g. DWR), anti-grease or non-stick
     treatments, membranes or laminates, coatings, inks, adhesives, and
     processing aids used in manufacture.

  2. If yes: the specific PFAS used (name and CAS number where known), the
     function it serves, and the amount or concentration range per item.

  3. If no: an affirmative statement that no PFAS is intentionally added to
     the item, signed by a person authorized to make the representation.

  4. Whether this answer also holds for all lots shipped to us since
     [DATE], and whether you will notify us in writing before any change in
     chemistry, supplier, or finishing process that could alter it.

A short signed statement on your letterhead (or a reply to this email from
a responsible officer) is sufficient. We ask for a response by
[DATE — TWO WEEKS OUT].

This information is required for state regulatory compliance. We will keep
technical details confidential and use them only for compliance purposes.

Thank you — a clear answer either way lets us keep ordering with
confidence.

Sincerely,

[NAME]
[TITLE]
[YOUR COMPANY NAME]
[EMAIL / PHONE]

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