Harmar Mobility AL003 Installation & Owner's Manual page 17

PLEASE FILL OUT ALL FIELDS AND RETURN WITHIN TEN (10) DAYS OF PRODUCT INSTALLATION.
Fax completed form to 1-866-234-5680 or mail to:
Harmar, ATTN Warranty Department, 1500 Independence Blvd., Suite 220, Sarasota FL 34234.
PRODUCT INFORMATION
Model:
Serial Number:
Purchase Date:
Installation Date:
INSTALLER INFORMATION
Company Name:
Contact Name:
Address:
Phone:
Fax:
Email:
APPLICATION INFORMATION
 
Scooter Power Wheelchair
 
Wheelchair N/A
Year:
Manufacturer:
Model:
PURCHASER INFORMATION
Name:
Address:
Phone:
Email:
ADDITIONAL INFORMATION
How did you hear about Harmar?

Harmar Dealer

Internet

Magazine
Which:

Friend or Acquaintance

Saw Harmar product somewhere

Other:
I purchased my Harmar lift because of:

Style/Appearance

Harmar Representative

Previous Experience

Ease of Use

Recommendation

Price/Value
AL003: Installation/Owner's Manual
22DEC2021 | 630-00096-B
AL003: SECTION 5
WARRANTY
17