HOSS - Owner's Manual 45
REMEMBER. . .
It is in your best interest to see that you (not your dealer) properly
complete this card and see that it is returned to ConvaQuip Ind., Inc.
Dear Friend:
Thank you so much for your purchase of a HOSS power wheelchair! We value your trust in us and we will
do everything we can to keep you happy. You're in a special group now. Thousands of people before you have
trusted ConvaQuip to provide them with the highest quality mobility products available. They and you have made
HOSS the most valuable wheelchair.
We hope that you have read the Owners Manual completely, and that you understand all of the safety
precautions and recommendations that apply to your particular wheelchair. If you have any questions, please ask
you ConvaQuip dealer. They can help explain any points that you do not understand.
In addition, your dealer will be glad to help you with any of your other ConvaQuip needs. Situated close to
you, they are in the best position to provide you with assistance and service.
The following warranty card must be filled out in order for ConvaQuip Ind., Inc. to:
1. effectively warranty your product in case of a problem
2. to properly follow the guidelines laid down by the Food & Drug Administration and to
3. allow us to locate you in the event of a product recall or modification
We also ask several questions about you to help us better understand the needs of our customers. The
information you provide us helps to keep our power chairs at the leading edge of quality and functionality and we
hope that we can count on you to help us. ConvaQuip always values the options of our customers and you may
write us at any time to relate to us your "HOSS Experience" good (or not so good).
For Service Call:
Dealer:
City, St,:
Your Serial Number is:
(sign)
C
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lo
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g
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DEALER NAME
(if different from above)
____________________
YOUR NAME ___________________________________
ADD1 _________________________________________
ADD2 __________________________________________
CITY, ST, ZIP ___________________________________
PHONE______/____________
Date Purchased __/__/___
To help us better understand our customers,
we would like to
know a little about you. Please fill in all the information you can.
AGE:__________WEIGHT: _____________HEIGHT:___________
Why did you purchase a power wheelchair (PWC)?
Arthritis ( ) Injury
( ) C.O.P.D. ( ) MS/MD ) Other _____________________________
Is this the first ( ) or second ( )PWC you have purchased?
How did you become aware of PWC?________________________
How long do you ride your PWC daily?
1-2 hrs ( ) 2-4 hrs ( ) 4-6 hrs ( ) More ( )
Was Medicare ( ) or a private Insurance ( ) used?
Do you own or have a power chair or scooter? ( ) Yes ( ) No
What influenced your decision to purchase? (Check all that apply)
Price ( ) Features ( ) Colors ( ) Comfort ( ) Power ( )
Were you satisfied with your purchase? (if not why?)
________________________________________________________
What could we do better?
(features, option, etc.)
_________________________________________________________
What other brands did you look at:
_____________________________
Which TV shows do you watch daily?__________________________
Which type of radio station do you listen to daily?________________
Do you read the newspaper regularly?__________________________
Which magazine do you read regularly?_________________________
Additional Comments:
______________________________________
