Product Registration
Thank you for purchasing an
ActiveCare power mobility product!
Your ActiveCare product will provide you years of dependable service and mobility
ease. To validate your product’s warranty, you must complete this form and return it to
ActiveCare Medical immediately.
Please print or type.
Your Name
Your Address
City State
Zip
Phone Number
E-mail Address
( )
-
Product Information
Model Date
Purchased
/ /
Month Day
Year
Serial Number
Dealer Purchased From
Dealer Address
City State
Zip
Phone Number
( ) -
www.ActiveForever.com
