I have inspected this equipment and find it in correct working condition. To the best of my knowledge, the customer and
his/her personnel are aware of, and agree to the above procedures.
Signed: ________________________________________________________________________ Date: ______________
(Dealer Representative)
The equipment has been thoroughly checked by the above named dealer representative, and I am satisfied with his/her
instructions. I have also read, understand, and agree to reverse side of page.
Signed: ________________________________________________________________________ Date: ______________
(Customer)
IT IS VERY IMPORTANT THAT THIS FORM IS FILLED OUT COMPLETELY & ACCURATELY. IF WE CANNOT READ THE
PURCHASER’S INFORMATION OR IT IS INCORRECT, OUR CUSTOMER LIST WILL NOT BE ACCURATE.
IMPORTANT - THIS FORM MUST BE RETURNED TO THE
CUSTOMER DATA DEPARTMENT WITHIN TEN (10)
DAYS IN ORDER TO VALIDATE WARRANTY
Customer Data Department
6750 Millbrook Road
Remus, MI, USA 49340
Phone: (800) 952-0178 in USA
Phone: (989) 561-2270
Fax: (989) 561-2273
E-mail: www.banditchippers.com
Copyright 1-15 FORM #WV-122
WARRANTY VALIDATION FORM
(HAND FED CHIPPER)
1. _______ Customer has been instructed and understands operation and all safety aspects of operating the equipment.
2. _______ Customer has been instructed and understands that everyone within 100 feet (30 m) of machine must wear
personal safety equipment (i.e. hard hat, face shield, safety glasses, gloves, ear protection, etc.)
3. _______ Customer has been instructed and understands equipment maintenance schedules, procedures, and that it
is their responsibility to perform maintenance that includes periodic relief valve adjustments, retightening
all fasteners as needed, periodic cleaning of flow divider, clutch and belt adjustments, etc.
4. _______ Customer has been advised and understands not to reach into the infeed hopper with hands or feet. The
machine operators must always be located within easy reach of all feed control and shut down devices.
5. _______ Customer understands that the wooden push paddle must be used to push small debris into the chipper
and, that they are not to reach or kick debris into the infeed hopper area of the machine.
6. _______ Customer understands the purpose of and how to operate the last chance device, and if used the machine has been
operated in an unsafe manner. Customer understands to never attempt to override any safety devices or guards.
7. _______ Customer has been instructed and understands to always remove the ignition key and completely disconnect battery
from cables, wait for the chipper disc/drum to come to a complete stop, and to install the disc/drum lock before
performing any type of maintenance on the machine. Allow all the time necessary for the disc/drum to come
to a complete stop before opening the disc/drum housing or starting any maintenance or service procedures.
Customer has been shown and understands the purpose of the beltshield inspection hole and to not attempt any
maintenance until belts are visually confirmed to have come to a complete stop.
8. _______ Customer has been instructed and understands: To Not operate this machine without the factory approved
hood pin assembly in place and padlocked. To Not operate this machine with any type of make shift hood
pin. To Not operate this machine under any circumstances with the chipper hood open or unsecured.
9. _______ Customer has reviewed and understands limited warranty, and all written and visual instructions.
10. _______ Customer has received, been advised, and understands the manuals, and the Safety/Service video supplied
with the chipper. A video is supplied for equipment models as available.
11. _______ All Danger, Warning and Operational decals are properly displayed on equipment and fully understood by customer.
12. _______ Customer has been instructed, understands, and agrees that all potential operators must: See the supplied video,
be instructed on all the Danger, Warning and Operational decals, read the manual and follow the procedures.
13. _______ I have been advised of all safety options.
White-Bandit Industries, Inc. copy / Yellow-Dealer copy / Pink-Customer copy
PURCHASER / OWNER INFORMATION:
Company Name __________________________________________________ Contact Name ______________________________
Mailing/Street Address _____________________________________________________ City _______________________________
State ____________________ Zip Code _________ Country ___________________ Telephone Number ( ___ ) _____________
E-mail _______________________________________ Machine Model No. _____________ Date Put Into Service _____________
Machine Serial No. __________________________________ Machine Work Order No. _____________ Machine Hours _________
Engine Make ______________________________ Engine Serial No. ___________________________ Machine Color _________
DEALER / SELLER INFORMATION:
Dealer/Seller Name ________________________________________________ Contact Name _______________________________
Mailing/Street Address _____________________________________________________ City _______________________________
State ____________________ Zip Code _________ Country ___________________ Telephone Number ( ___ ) _____________
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