28
POWER CHAIR INDIFICATION NUMBER
To ensure the correct after sales service and warranty service support,
please write down the power chair indication number that is stuck on
the back right-hand side of the frame.
………………………………………………………………………………………………………
Warranty Application Form
Name
Sex
口
Male
口
Female
Date of Birth
Year Month Day
Address
Model
口
Liberty 116
口
Liberty 118
口
Liberty 120
口
Liberty 122
口
Liberty 124
Power chair :
VIN
Motor Serial No:
Controller #
Date of Purchase
Year Month Day
Purchaser Signature
9 . W A R R A N T Y
Model
口
Mambo 116
口
Mambo 118
口
Mambo 120
口
Mambo 122
口
Mambo 124
VIN
Motor serial #
Controller #
Indication Number