28
VIN
(POWERCHAIR IDENTIFICATION NUMBER)
To ensure the correct after sales, service and warranty service
support, please write down the power chair identification number
found on the rear right-hand side of the frame.
………………………………………………………………………………………………………………………………
Warranty Application Form
Name
Date of Birth
Year Month Day
Address
Model
VIN
Power chair VIN:
Motor Serial No:
Controller #
Date of Purchase
Year Month Day
Purchaser Signature
Please Mail To:
Drive Medical Design and Manufacturing
99 Seaview Blvd
Port Washington, NY 11050
Attn: Warranty Department
9. WARRAN TY
Model
IMAGE EC
VIN
Motor serial #
Controller #
Identification Number
