Warranty Card

To validate warranty this form must be filled out completely within 5 days of installation.

    Part Number (required):

    Serial Number (required):

    Install date:

    Owner Name (required):

    Owner Address:

    Owner City:

    Owner State:

    Owner Zip Code:


    Owner Phone Number:

    Owner Email:

    Dealer Name:

    Dealer Contact (required):

    Dealer Number:

    Dealer Address:

    Dealer City:

    Dealer State:

    Dealer Zip Code:

    Dealer Country:

    Dealer Phone Number:

    Dealer Fax Number:

    Dealer Email:

    Dealer Web Address:

    Mounting Information

    Please indicate which bracket was used on the installation of hand control (if applicable)



    Vehicle Information

    Make (required):

    Model (required):

    Year (required):

    Air Bag:

    Steering Wheel:


    Dealer Information

    I of certify that all items on "Final check-out" (located in the back of dealer manual) have been completed and checked. Customer has been given complete instructions on how to operate hand controls.

    Installation Information

    Ease of Installation: