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Issue 4 38
Customer Name.
Address
Postcode
Service history
Date chair purchased
Model
Colour
Serial No.
Dealer Stamp
Date: Signed:
Dealer Stamp
Date: Signed:
Dealer Stamp
Date: Signed:
Dealer Stamp
Date: Signed:
YEAR 1 2 3 4
Service dates
Controller
On/off switch
Output plug
Operation
Dynamic braking
Programmable
settings
Batteries
Levels
Connections
Discharge test
Wheels/tyres
Wear
Pressure
Bearings
Wheel nuts
Motors
Wiring
Noise
Connections
Brake
Brushes
Chassis
Condition
Steering
YEAR 1 2 3 4
Service dates
Upholstery
Seat
Back
Armpads
Electrics
Condition
of loom
Connections
Lights
(where fitted)
Test run
Forwards
Reverse
Emergency
stop
Left turn
Right turn
Up/down slope
Over obstacles
Parking brake
(where fitted)
List items repaired/adjusted
This section is designed to assist you in keeping a record of any service and repairs to your Wheelchair. Should you
decide to sell or exchange your vehicle in the future, this will prove most helpful to you. Your Service Agent will also
benefit from a documented record and this manual should accompany the Wheelchair when service or repair work
is carried out. The Service Agent will complete this section and return the manual to you.