Copyright 2/17 FORM #WV-126
WARRANTY VALIDATION FORM
(BANDIT TRACK CARRIER)
PURCHASER / OWNER INFORMATION:
Company Name __________________________________ Contact Name _____________________
Mailing/Street Address _______________________________________ City _______________________
State ___________________ Zip Code _______ Country ______________ Telephone Number ( __ ) ________
E-mail ____________________________ Machine Model No. _______ Date Put Into Service ______
Machine Serial No. ____________________ Machine Work Order No. ________ Machine Hours _______
Engine Make _________________ Engine Serial No. __________________ Machine Color _______
DEALER / SELLER INFORMATION:
Dealer/Seller Name _______________________________ Contact Name _____________________
Mailing/Street Address _______________________________________ City _______________________
State ___________________ Zip Code _______ Country ______________ Telephone Number ( __ ) ________
IMPORTANT - WARRANTY WILL BE DEEMED NULL AND
VOID IF THIS FORM IS NOT FILLED OUT COMPLETELY AND
ACCURATELY AND RETURNED TO THE CUSTOMER DATA
DEPARTMENT WITHIN 10 DAYS OF EQUIPMENT DELIVERY
I have inspected this equipment and nd it in correct working condition. To the best of my knowledge,
the customer and his/her personnel are aware of, and agree to the above procedures.
Signed: ________________________________________________________ Date: ______________
(Dealer Representative)
The equipment has been thoroughly checked by the above named dealer representative, and I am
satised with his/her instructions. I have also read, understand, and agree to reverse side of page.
Signed: ________________________________________________________ Date: ______________
(Customer)
1. _____ The customer has received instruction and fully understands all operational, safety and maintenance
requirements of the equipment.
2. _____ The customer has received instruction and fully understands that everyone needs to stay back 300 feet (90
m) in all directions of machine while in operation. Failure to do this could result in severe injury or death.
3. _____ The customer has received instruction and fully understands the equipment maintenance schedules and
procedures. The customer understands that it is their responsibility to perform scheduled maintenance that includes
retightening all fasteners as needed, belt adjustments, lubrication and other items.
4. _____ The customer has received instruction and fully understands not to reach near cutter head with hands or
feet or to be located near debris eld with engine running.
5. _____ The customer has received instruction and fully understands that the operators must always be located
within easy reach of all feed control and shut down devices.
6. _____ The customer has received instruction and fully understands purpose of and how to operate the shut down
and shut-o devices, and will not attempt to override any safety devices or guards.
7. _____ The customer has received instruction and fully understands to not start grinding or mowing without checking
for power lines, water lines, sewer lines, phone lines, etc. in the area above or below the ground level.
8. _____ The customer has received instruction and fully understands that before performing any maintenance
on the machine the ignition key must be removed, the cables must be completely disconnected from the battery,
the cutter head must have come to a complete stop, and be securely on the ground before performing any type of
maintenance on the machine. The customer understands they must allow the necessary time for the cutter head to
come to a complete stop.
9. _____ The customer has received instruction and fully understands that the machine is not to be operated without
all safety devices installed and working properly; this includes guards, shields, deections chains, and other devices.
10. _____ The customer has reviewed and fully understands limited warranty, and all written and visual instructions.
11. _____ The customer has received instruction and fully understands that warranty will not apply if the machine is
operated with replacement parts or equipment not manufactured or recommended by Bandit Industries, Inc.
12. _____ The customer has received, been advised, and understands the manuals, and the Safety/Service video
supplied with the machine. A video is supplied for equipment models as available.
13. _____ All Danger, Warning and Operational decals are properly displayed on equipment and fully understood
by customer.
14. _____The customer has been instructed, understands, and agrees that all potential operators must: See the
supplied video, be instructed on all the Danger, Warning and Operational decals, read the manual and follow the
procedures.
Customer Data Department
6750 Millbrook Road
Remus, MI, USA 49340
Phone: (800) 952-0178 in USA
Phone: (989) 561-2270
Fax: (989) 561-2273
Website: www.banditchippers.com
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