Page | 15
Buyers Registration Form
Top Gun Mobility Scooter
NOTICE: SELLING DEALER SHOULD COMPLETE THIS FORM AT TIME OF
SALE TO REGISTER WARRANTY.
Customer Name: _________________________________________________
Address:________________________________________________________
City:___________________________ State: _________ Postcode:__________
Telephone:__________________________ Date of Purchase:______________
Email Address: ___________________________________________________
Selling Dealer:
Top Gun Mobility
21 Brisbane Street, Ipswich QLD 4305
Phone :
07 3282 7788
Email :
Model:
____________ TG400R ______________
Serial Number:
_______________________________________________
Colour:
_______________________________________________
Type of Purchase: Consumer
Rental
Other
Customer Signature
Dealership Representative Signature
