Premier PD500 - Warranty Registration Form

4
PREMIER
WARRANTY REGISTRATION
DATE PURCHASED_____________________________
MODEL NO.___________________________________ SERIAL#________________________________
OWNER INFORMATION
OWNER’S NAME_____________________________________ PHONE___________________________
COMPANY NAME___________________________________________________________________________
ADDRESS_________________________________________________________________________________
CITY____________________________________________ STATE/PROVIDENCE __________________
ZIP CODE__________________________________ COUNTRY__________________________________
DEALER INFORMATION
DEALER SALESMAN________________________________ PHONE__________________________
DEALER NAME _____________________________________________________________________________
ADDRESS__________________________________________________________________________________
CITY____________________________________________ STATE/PROVIDENCE __________________
ZIP CODE__________________________________ COUNTRY__________________________________
INSTALLATION & APPLICATION INFORMATION
This PREMIER Driver-Breaker Attachment will be mounted on:
SKID STEER MAKE (Brand)_______________________ MODEL_________________________________
APPLICATION______________________________________________________________________________
This PREMIER Hydraulic Driver-Breaker has been accepted in good condition and I have been instructed by the dealer to
read and understand the entire Operator’s Manual for proper installation, proper and safe operation, preventative
maintenance, service, warranty, and all other information covered in the Operator’s Manual. I also understand that all
operators must read and understand the entire Operator’s Manual.
OWNER’S SIGNATURE_______________________________________ DATE______________________
DEALER’S SIGNATURE_______________________________________ DATE______________________
THIS PAGE MUST BE RETURNED WITHIN 10 DAYS OF PURCHASE TO VALIDATE WARRANTY
MAIL TO: PREMIER
2707 Lofty Drive
Ft. Wayne, IN 46803