14
BUYER’S REGISTRATION FORM
Mobility Scooters
NOTICE: SELLING DEALER SHOULD COMPLETE THIS FORM
AT THE TIME OF SALE TO REGISTER WARRANTY.
Customer Name: ________________________________________
Address: _______________________________________________
City: ___________________ State ______Zip Code: _____________
Telephone: ________________ Date of Purchase: ______________
Selling Dealer: __________________________________________
Dealer’s Address: ________________________________________
City:__________________ State:_______ Zip Code:_____________
Dealer’s Telephone Phone: ________________ Fax: ____________
Model Number: _________________________________________
Serial Number: ______________________ Colour: _____________
Type of Purchase: Consumer Rental Other
Date of Purchase: _______________________________________
_______________________
Customer Signature
