LHZ RF models - Page 19

Please send this form back to your retailer. If you have circled “NO” in any area
above a Customer Service representative will contact you directly.
To be signed by the purchaser
Signed: ......................................................................... Date: ...............................
Name: ...................................................................................................................
Address: ................................................................................................................
For office use only:
Installed by: ......................................................... Account Number: ....................
Processed by: ....................................................... Date: .......................................