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Vehicle Identification Number (VIN)
WARRANTY AND REGISTRATION
Examine your vehicle for any damage. Should any
damage have occurred during delivery, notify the
carrier at once with any claims.
Review the service agreement, delivery checklist
and warranty registration form with your sales repre-
sentative. The form must be signed by the con-
sumer and retailer. A hard copy is available upon
request.
The warranty registration form must be processed
electronically by the sales representative to activate
the warranty. See the Warranty for detailed terms
and provisions applicable to this vehicle.
Record the last eight digits of the vehicle identifica-
tion number (VIN) in the space provided for future
reference. This information must be provided when
filing a warranty claim or ordering parts.
Mobility Conversion Service Agreem
ent
Vehicle Delivery Checklist
W arranty Registration
Customer Name
Web Referral Code
Address
City
State
Zip
Phone
VIN (last 8)
Date of Purchase
THE BRAUN CORPORATI ON MOBILIT
Y CONVERSI ON SERVI CE AGREEMEN
T
This agreement is intended to clarify the
service responsibilities to the Braun mob
ility conversion after the initial delivery
of the
vehicle. This agreement shall be exe
cuted and electronically submitted
to Braun w ith each conversion sale.
Listed below is the identification of the B
raun authorized selling Mobility Retailer,
and the Braun authorized local servicing
Mobility Retailer who has agreed to serv
ice the mobility conversion portion of this
vehicle per the applicable Braun service
manuals and guidelines.
By signing below, the purchaser of the m
obility conversion acknowledges the ado
ption of the local servicing Mobility Retail
er as
the primary provider of service for the m
obility conversion portion of this vehicle.
All local servicing retailers must be an
authorized Braun Mobility Service excelle
nce Retailer (MSE-certified in vehicle con
versions).
Should the owner of the mobility convers
ion require service outside the local serv
icing area, they may take the mobility
conversion to any Braun authorized mob
ility conversion retailer located within th
e United States. If the owner needs ass
istance
in identifying a local servicing mobility re
tailer, they may either call 1-800-THE-LI
FT, or check the Braun website at:
www.braunability.com
.
Note: This agreement only applies to the
servicing of the Braun mobility conversio
n. Ancillary equipment, such as tie dow
ns or
hand controls, will be the responsibility
of the mobility retailer that installed thos
e products and will not be covered unde
r the
Braun mobility conversion warranty. If
there are issues relating to the chassis a
nd/ or conversion, it would be in the best
interest
of the mobility vehicle owner to contact
the Braun authorized local servicing Mob
ility Retailer listed below before taking th
e
vehicle to their local car dealer.
Retailer Signature
________________________________
________________________________
____________________________
Selling Mobility Retailer will be the
servicing company
Selling Mobility Vehicle Retailer
Name
Dealer #
Address
City
State
Zip
Phone
The follow ing company to provide se
rvice:
Local Servicing Mobility Retailer
Name
Dealer #
Address
City
State
Zip
Phone
Exterior
Exterior clean and damage-free
Spare tire and jack location
Operation of remote control
Magnetic entry (if applicable)
Exterior activation of power door, kneelin
g and ramp
Manual operation of door and ramp from
exterior
Interior
I nterior
Gauges and instrumentation
Location of interior switches to operate
accessible
features
Manual operation of door and ramp from
interior
Operation of tie-downs
Operation of roll & tumble seating (if app
licable)
Operation of seat belts
Location of Braun controller
Additional
Review both OEM and Braun owner's m
anuals
Explain the Toyota Service Exchange Info
rmation
Program (Toyota Chassis Only)
Explain recommended preventive mainte
nance and
service schedules
Explain procedures for warranty repair w
ork
Inform Customer of dealership service h
ours
Advise Customer to receive and maintain
a signed
record of all service work performed
Complete and return warranty registratio
n to activate
warranty
List all aftermarket equipment. Use bran
d names and
model numbers where possible
I hereby acknowledge that the mobility
devices applicable to my vehicle have be
en demonstrated for me, and I fully und
erstand
and can operate this equipment. I have
been advised that wheelchairs may not
maintain their integrity in the event of a
collision. I hereby release and hold harm
less the Original Vehicle Manufacturer, T
he Braun Corporation, and its independe
nt
dealers from any liability associated with
injury to my person and property as a re
sult of my use of a wheelchair during a
collision. I have read and understand th
is entire form, including all disclaimers a
nd the Braun factory Limited Warranty.
All of
the information I have provided is correc
t.
Custom er:
I acknowledge that all items checked ha
ve been reviewed with
me.
________________________________
____________________
_
Customer Signature / Date
Sales Consultant:
All items checked have been reviewed w
ith the customer.
________________________________
____________________
_
Consultant Signature / Date
The dealer agrees to electronically subm
it this completed Mobility Conversion Se
rvice Agreement to BraunAbility immedia
tely
after the customer review takes place.
Additionally, the dealer agrees to mainta
in a copy of this executed document, wit
h the
appropriate signatures affixed, for a perio
d of six (6) years.
To ensure that completed records are m
aintained by the dealer, BraunAbility sha
ll periodically audit the applicable record
s to
determine dealer conformance. The dea
ler agrees to cooperate with BraunAbility
in providing copies of these records. Fail
ure to
comply with these terms may nullify any
obligation that BraunAbility may have to
pay warranty claims submitted by the de
aler.
I acknowledge the above agreement.
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