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JAZZY 1120/1170 WARRANTY REGISTRATION (Please type or print)
DATE PURCHASED ___________________________ SERIAL # ________________________
NAME ___________________________________________________________________
ADDRESS _________________________________________________________________
CITY ____________________________________ STATE ______ ZIP ________________
DEALER NAME ______________________________________________________________
ADDRESS _________________________________________________________________
CITY _____________________________________ STATE _______ ZIP________________
OPTI0NAL INFORMATION TO HELP US IMPROVE OUR PRODUCTS
AGE____ WEIGHT______ HEIGHT______ SEX______
PHYSICAL LIMITATIONS-IF ANY ___________________________________________________
AVERAGE HOURS PER WEEK SPENT OUT OF THE HOME ____________________________________
FAVORITE ACTIVITIES _________________________________________________________
FAVORITE JAZZY 1120/1170 FEATURES ______________________________________________
If you know of other persons who could benefit from our products, please fill in the following:
NAME ___________________________________________________________________
ADDRESS _________________________________________________________________
CITY _____________________________________ STATE ______ ZIP CODE ____________
ATTENTION NEW JAZZY 1120/1170 OWNER:
PLEASE INDICATE YOUR UNDERSTANDING OF YOUR JAZZY 1120/1170 BY CHECKING OFF THE FOLLOWING:
I have read and fully understand:
¨ Comfort Adjustments ¨ Operation
¨ Batteries and Charging ¨ Care and Maintenance
I also understand:
¨ The function of the freewheel levers.
¨ I should use only Sealed Lead Acid or Gel Cell type batteries. JAZZY 1120/1170 batteries must be sealed, deep
cycle and maintenance free. Any other type of battery will hinder performance and will void the warranty.
¨ My dealer has instructed me on how to operate my JAZZY 1120/1170.
SIGNATURE ________________________________________________________________
TELEPHONE (Area code included) __________________________________________________
COMMENTS (Please type or print)
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