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WARRANTY AND REGISTRATION
Vehicle Identication Number (VIN)
M ob il i t y Con v e r sio n Se r v ic e Ag r e e m e n t
Ve h icle De live ry Ch eckl ist
W a r r a n t y Re g ist r a t i on
Cust om er Name Web Refer r al Code
Add re ss City Sta t e Zip
Phone Emai l
VI N ( l ast 8 ) Dat e of Purch ase
TH E BRA UN CO RPOR ATI ON MO BI LI TY CON VER SI ON SER VI CE A GREEM ENT
This agr ee m en t is int en d ed to cla ri fy t h e s er vi ce resp on si bi li ti es to th e Bra un m ob il it y con v er sio n aft er t h e i ni t ia l deli ve r y of th e
veh icle. T hi s ag r ee m en t sh a l l be ex e cu t e d a nd e le ct r o n ic a ll y sub m i t t e d to Br a u n w i t h ea ch co n v er s io n sa le .
List ed bel ow is th e iden t if ic at io n of th e Brau n aut h or i zed sell in g Mobi li t y Reta ile r , and th e Bra un au t ho ri zed lo cal ser vi cin g
Mobi li t y Reta ile r wh o has agr eed t o serv ice th e mob ility co nver sion po rti on of t his veh icle per t he app licabl e Braun ser vice
ma nu al s an d gu ide lin es.
By sign in g bel ow , th e pur ch ase r of th e mo bil it y con v er si on ack no w led ge s t h e ado pt i on of th e local ser v ici ng Mob il it y Ret ai ler as
th e prim ary pr ovid er of se rvice f or th e mob ilit y conv ersio n port ion o f this v ehicl e. All l ocal ser vicin g ret ailer s must b e an
aut h or i zed Bra un Mob il it y Ser v ice ex cel len ce Reta il er ( MSE- cer t if ie d in veh icl e conv er si on s) .
Shou ld th e owne r of th e mob ilit y conv ersion r equir e serv ice out side t he local ser vici ng area , th ey may t ake t he mo bilit y
conv e rs ion t o any Br au n aut h or ize d mo bi li t y conv er si on re t ai ler lo cat e d wit h in t he Uni t ed Sta t es. If t he ow ner n eed s assist a nce
in iden t i fy in g a l oca l serv i cin g mo bi li t y ret a il er , th ey m ay ei t he r call 1- 8 0 0- THE- LI FT, or che ck th e Bra un w ebs it e at:
ww w.b raun abili ty. com.
Not e: T hi s a gr ee m en t on ly ap pl ies to t he ser vi cin g of th e Brau n m obi li t y con ve rs ion . Ancil lar y eq ui pm e nt , su ch as t i e dow ns or
han d con t ro ls, w ill be th e resp o nsi bi li t y of th e m obi lit y r et ai le r th at i nst a lle d th ose pr od uc t s a nd wi ll no t be cov er ed un de r th e
Bra un m ob il it y con v er sio n war r an t y . If th er e are issu es rela t in g to th e chas sis and / o r conv er si on , it wo u ld be in th e b est i nt e re st
of th e mo bil it y v eh icl e o w ne r to con t act t h e Brau n aut h or iz ed loca l serv ic in g Mobi lit y Retai ler list ed bel ow befo re tak ing t he
veh ic le to th ei r loca l car deal er .
Reta iler Sig natu re
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Se ll in g Mo b il it y Re t a i le r w ill be t h e se r vi ci n g com p a n y
Se ll in g Mo b il it y V e hi cl e Re t a il e r
Nam e Deal er #
Addr ess
City Sta t e Zip
Phone
Th e foll ow ing co mpa ny t o prov ide se rv ice:
Loca l Se r vi ci n g Mo bi l it y Re t a i le r
Nam e Deal er #
Addr ess
City Sta t e Zip
Phone
Ext e r i or
Ext er io r clean an d dam a ge - fr ee
Spar e tir e and j ack loca tion
Oper at i on of re m ot e cont r o l
Magn et i c e nt r y ( if ap pli ca ble )
Ext er io r act iv at i on of pow e r doo r, k ne eli ng an d ram p
Manu al oper atio n of door an d ram p from e xter ior
In t er io r
I nt e r io r
Gaug es and in st ru m e nt at i on
Locat i on of int e ri or sw it ch es to op er at e access ibl e
fea tur es
Manu al oper atio n of door an d ram p from i nter ior
Oper at i on of ti e- d ow n s
Oper atio n of rol l & tum ble seat ing ( if appl icable )
Oper at i on of seat b elt s
Locat ion of Br aun con tr oller
Add i t io n a l
Revie w bot h OEM and Br aun ow ner' s ma nuals
Expl ain th e Toyot a Serv ice Exch ange I nfor mat ion
Progr a m ( Toy ot a Chass is Only )
Expl ain r ecom m e nd ed pr eve nt i ve ma in t ena nce an d
serv ice schedu les
Expl ain p ro ced ur es fo r war r an t y rep ai r wo rk
In f or m Cust om e r of deal er shi p serv i ce h ou r s
Adv ise Cust om er to re ceiv e and m ai nt a in a s ig ne d
reco r d of a ll ser vi ce w o rk pe rf or m ed
Com pl et e and re t ur n war r an t y re gi st r at io n to act iv at e
war r an t y
List all af te rm a rk et eq u ipm e nt . Use br an d nam e s an d
mo del nu m be rs wh er e possi ble
I h ereby ac know ledge t hat t he mo bilit y dev ices app licabl e to my v ehicl e have be en dem onst rat ed for m e, and I f ully u nder stan d
and can op er at e th is equ ip m en t . I h av e been ad v ise d th at wh ee lch ai r s m a y not m a in t ai n th eir in t eg r it y in th e eve nt o f a
coll ision. I h ereby r elease an d hold ha rml ess the O rigin al Vehi cle Manu factu rer , The Brau n Corp orat ion, a nd it s indep enden t
deal ers fr om an y liab ility ass oci at ed wi t h inj u r y to m y per so n and pr op er t y as a re su lt of m y use of a w h eel cha ir du r in g a
coll ision. I ha ve rea d and und erst and t his ent ire fo rm, i nclud ing all d isclaim ers and t he Brau n fact ory Lim ite d Warr anty . All o f
th e inf or m at i on I ha ve pr ov i ded is cor re ct .
Cust o m e r :
I ack no wl ed ge th at a ll it em s check e d hav e been re vi ew ed wi t h
me .
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Cust om e r Sign at u r e / Dat e
Sa le s Con su lt a n t :
All ite m s c hec ked ha ve bee n rev ie we d wit h th e cust om er .
____________________________________________________
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Consu lt a nt Si gn at u r e / Dat e
The deal er ag r ees to elec t ro ni cal ly su bm i t t hi s co m pl et e d Mobil it y Con ve r sio n Serv ic e Agre em en t t o Brau n Abi li t y im m ed iat e ly
aft e r th e cust om er r ev ie w ta ke s p la ce. Addi t io nal ly , t he dea ler ag r ees to m ai nt a in a co p y of th is exec ut ed do cu m en t , wit h t he
app ropr iate s ignat ures a ffix ed, fo r a per iod of si x (6) y ears.
To ens ure t hat com plet ed reco rds ar e main tain ed by t he deal er, Br aunAb ilit y shall pe riodi cally a udit t he app licabl e recor ds to
det erm ine de aler con for manc e. The d ealer a grees t o coope rate w ith Br aunAb ilit y in pr ovid ing cop ies of t hese rec ords. Failur e to
com ply wi th th ese ter ms may n ulli fy any obl ig at i on th at Br a un Ab ili t y ma y hav e to pay w ar r an t y clai m s subm i t t ed by t he dea ler .
I ac know ledge t he abov e agre emen t.
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Examine your vehicle for any damage. Should any
damage have occurred during delivery, notify the
carrier at once with any claims.
Review the service agreement, delivery checklist
and warranty registration form with your sales repre-
sentative. The form must be signed by the con-
sumer and retailer. A hard copy is available upon
request.
The warranty registration form must be processed
electronically by the sales representative to activate
the warranty. See the Warranty Booklet for detailed
terms and provisions applicable to this vehicle.
Record the last eight digits of the vehicle identica-
tion number (VIN) in the space provided for future
reference. This information must be provided when
ling a warranty claim or ordering parts.
