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LIBERTY™ 324, 424, 624, 324 MINI, 624 MINI & 624 RELIANCE
WARRANTY REGISTRATION
(Please type or print)
DATE PURCHASED: __________________________ SERIAL NO.: _______________________
NAME: ____________________________________________________________________________
ADDRESS: _________________________________________________________________________
CITY: ___________________________________ STATE: ____________________ZIP: __________
DEALER NAME: ___________________________________________________________________
ADDRESS: _________________________________________________________________________
CITY: ___________________________________ STATE:____________________ZIP: __________
OPTIONAL INFORMATION TO ASSIST US IN DEVELOPING FUTURE PRODUCTS
AGE: _________ WEIGHT: ____________ HEIGHT: _________ SEX: ___________
PHYSICAL LIMITATIONS – IF ANY: ___________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
FAVORITE ACTIVITIES: _____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
FAVORITE LIBERTY™ FEATURES: __________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
If you would like us to send information about the LIBERTY™ PERSONAL MOBILITY
VEHICLES to someone you think will Benet from it please ll in the following:
NAME: ____________________________________________________________________________
ADDRESS: _________________________________________________________________________
CITY: ___________________________________ STATE: ____________________ZIP: __________
FOLD TOP TO HERE,
MAIL TO ADDRESS ON BACK.