850 REV04 REV DATE: 09/03/2014
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Warranty Registration Form
To validate your Future Mobility HealthCare warranty, please complete the below form and
return it the address at the end of this form. Visit online at www.futuremobility.ca for more
Future Mobility Products.
Name: ____________________________
Street Address: _________________________________________________
City/Country/Postal Code: ________________________________________
Telephone: _______________________________
Purchased Date: _______________________________
Purchased From (Dealer Name and Address):_________________________
Product Purchased: _____________________________________________
Serial Number: ___________________________________________
Print and Mail it to:
Future Mobility Healthcare Products
3223 Orlando Drive
Mississauga, Ontario, L4V 1C5
Fax: 905-671-3377
