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Serial # _______________
CUSTOMER TO COMPLETE
DEALER TO COMPLETE
Mr./Mrs./Ms.
___________________________ ________________________________
Your Name (Please Print)
Company Name
___________________________ ________________________________
Address
Dealer’s Address
___________________________ ________________________________
City, State, Zip Code
City, State, Zip Code
___________________________ ________________________________
Telephone Number
Dealer’s Telephone Number
___________________________ ________________________________
Year / Make / Model of Vehicle
Date of Installation / Purchase
________________________________
Dealer’s Signature
“Proof of Purchase” w hich includes the store name and date of purchase must
accompany all warranty returns.
It is the purchaser’s responsibility to keep this card for any future warranty
service.
