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WARRANTY REGISTRATION (3 part form - please print)
This form must be filled out by the dealer and signed by both the dealer and the customer at the time of delivery.
Delivery Date:
mm
COMPANY / CUSTOMER NAME
Phone:
Mobile phone:
Email :
@
Street Address:
City:
Postal/Zip
Machine Serial Number
DEALER INSPECTION REPORT
Blowers and Airlock Turn Freely
Boom Anchored in Place
Check Tire Pressure
Hydraulic Hose Connections Tight
Hydraulic Hoses Free and Fitting
Wheel Bolts Tight
Lubricate Machine
Check Oil Level in Reservoirs
Belts are Tight
O-Rings in Place
I have thoroughly instructed the buyer on the above described equipment which review included the Operator's
Manual content, equipment care, adjustments, safe operation and applicable warranty policy.
Date ____________________Dealer's Rep. Signature
The above equipment and Operator's Manual have been received by me and I have been thoroughly instructed as to
care, adjustments, safe operation and applicable warranty policy.
Date
___________________
199 05042016
3 Part Form
Please Print
ULTRA-VAC MODELS 6614D, 7614D,8614D
Warranty Registration Form & Inspection Report
/ dd
/
yyyy
Prov/State
Country
Blower #1 Serial No.
Owner's Signature
WHITE
WALINGA
DEALER NAME
Phone:
Mobile phone:
Email :
Street Address:
City:
Postal/Zip
Blower #2 Serial No.
(if so equipped)
Guards Installed and Secured
All Safety Signs Installed
Reflectors and SMV Signs Clean
Review Operating and Safety Instructions
Engine Manual Supplied
Ultra-Vac Operating Manual Supplied
_________________________________________
________________________________________
YELLOW
PINK
DEALER
CUSTOMER
@
Prov/State
Country
Airlock Serial Number
SAFETY
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