PREMIER TECH Ecoflo Series - Appendix 4 | Notice of Ownership Change

1520230602 — Item #339914
APPENDIX 4 | NOTICE OF OWNERSHIP CHANGE
THIS FORM MUST BE RETURNED TO PREMIER TECH WATER AND ENVIRONMENT
1, Premier avenue, Premier Tech Campus, Rivière-du-Loup, Quebec G5R 6C1
or info.ptwe.na@premiertech.com
Have you recently sold or purchased a property where wastewater was treated by a Premier Tech system? Please complete
the information below to the best of your knowledge to ensure a quick and accurate update of the client file.
Name
Indicate if you are
Former owner
New owner
Premier Tech customer number
Address of the site where Premier Tech’s system is installed
Address Street City Province/State Postal code/Zip code
Name of new owner
Mailing address (if dierent from the site where the system is installed)
Address Street City Province/State Postal code/Zip code
Language of correspondence
English
French
Correspondence method
Email
Postal service
Phone
(office)
Phone
(home)
Email
I declare that the residence where a Premier Tech system is installed as indicated at the site address has changed
or will change ownership on this date:
Date
If you are the FORMER owner
I have provided the owner’s manual and the system warranty certificate that is included with this document to the new
owners. I informed them that local regulations require that the annual maintenance contract stipulating that maintenance
must be performed on the system be renewed every year (no later than 31 December of each year) and that this is
essential for them to benefit from the product’s warranties and to ensure that the system complies with the regulations.
Signature Date
If you are the NEW owner
I declare that I have received the manual owner’s and the warranty certificate and agree to abide by their conditions.
I understand that annual maintenance for all treatment systems is required by local regulations and that I must renew
my annual maintenance contract every year (no later than 31 December of each year) to benefit from the product’s
warranties and ensure that the system complies with the regulations.
Signature Date