Activeforever Image EC Mid Wheel Drive Reclining Power Wheelchair - Manual (Page 29)

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VIN (POWERCHAIR IDENTIFICATION NUMBER)
To ensure the correct after sales, service and warranty service
support, please write down the power chair identification number
found on the rear right-hand side of the frame.
………………………………………………………………………………………………………………………………
Warranty Application Form
Name
Date of Birth
Year Month Day
Address
Model
VIN
Power chair VIN:
Motor Serial No: Controller #
Date of Purchase
Year Month Day
Purchaser Signature
Please Mail To:
Drive Medical Design and Manufacturing
99 Seaview Blvd
Port Washington, NY 11050
Attn: Warranty Department
9. WARRAN TY
Model IMAGE EC
VIN
Motor serial # Controller #
Identification Number