TopGun Mobility AVENGER - Page 3

RETAIL ADVICE & BUYERS WARRANTY REGISTRATION
Selling Dealer to complete at time of sale in order to Register Warranty with Top Gun Mobility
Customers Email Address: ____________________________________________________________________
Customer: __________________________________
Model:
____________________________________
Address: ___________________________________
Serial Number: ______________________________
___________________________________________
Colour: ____________________________________
State:
______________ Postcode: ______________
Date of Sale: ________________________________
Phone: _____________________________________
Type of Purchase: Consumer / Rental / Other
SELLING DEALER:
___________________________________________
__________________________________________
___________________________________________
Customer Signature
___________________________________________
___________________________________________
_________________________________________
___________________________________________
Dealership Representative Signature