[Your full name]
[Street address]
[City, State ZIP]
[Phone] | [Email]

[Date]

Ford Motor Company
Customer Relationship Center
P.O. Box 6248
Dearborn, MI 48126

Re: Request for goodwill assistance, coolant intrusion engine failure
Vehicle: [Year] Ford [Model], [engine, e.g. 1.5L EcoBoost]
VIN: [17-character VIN]
Mileage at failure: [mileage]
Date of failure: [date]
Ford case number (if any): [case number]
Servicing dealer: [dealer name, city]

To the Customer Relationship Center and Regional Field Service Manager:

I am writing to request goodwill assistance for the engine failure on my vehicle listed above. The servicing dealer diagnosed [describe diagnosis, e.g. coolant intrusion into the cylinders] and recommended [short block / engine replacement] at an estimated cost of $[amount].

Ford has acknowledged this condition on certain EcoBoost engines through Customer Satisfaction Program 21N12, which provides a short block replacement within 7 years / 84,000 miles of the warranty start date. My vehicle [is outside that coverage by (time/miles) / was denied coverage because (reason)].

I have maintained the vehicle according to Ford's schedule. Service records are enclosed. [Add any relevant history, e.g. earlier coolant top-offs, misfire codes, prior visits.]

I respectfully ask that Ford:
1. Have a Regional Field Service Manager review this case; and
2. Cover [all / a substantial portion] of the repair cost [or reimburse the $(amount) I paid on (date)].

Thank you for your consideration. I can be reached at [phone] or [email].

Sincerely,
[Signature]
[Printed name]

Enclosures: repair order / estimate, service records, [other]