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Model No. _____________________________________________
VEHICLE
IDENTIFICATION NUMBER (V.I.N.)_____________________________
HIGH-VOLTAGE BATTERY
IDENTIFICATION NUMBER__________________________________
Owner: ______________________________________________
______________________________________________
No.
STREET
______________________________________________
CITY
STATE/PROVINCE
Purchase Date ________________________________________
YEAR MONTH DAY
Warranty Expiry Date __________________________________
YEAR MONTH DAY
To be completed by the dealer at the time of the sale.
DEALER IMPRINT AREA
NAME
ZIP/POSTAL CODE
APT
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