TopGun Mobility AVENGER - Page 5

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: ______________________________
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Colour: ____________________________________
State: ______________
Postcode: ______________
Date of Sale: ________________________________
Phone: ______
_______________________________
Type of Purchase: Consumer / Rental / Other
SELLING DEALER:
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______________________________
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Customer Signature
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Dealership Representative Signature