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.
Model
VIN
Motor serial #
.....................................................................................................................
Name
Sex
Date of Birth
Address
Model
VIN
Date of Purchase
Purchaser Signature
9 . W A R R A N T Y
口 Mambo 116 口 Mambo 118
口 Mambo 120 口 Mambo 122
口 Mambo 124
Controller #
Warranty Application Form
口 Male
Year
Month
口 Liberty 116 口 Liberty 118 口 Liberty 120
口 Liberty 122 口 Liberty 124
Power chair :
Motor Serial No:
Year
Month
口 Female
Day
Day
28
Indication Number
Controller #