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Vehicle Identication Number (VIN)
WARRANTY AND REGISTRATION
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.
M ob il i t y Con v e r si on Se r v ice Ag r e e m e n t
Ve h i cle D e li ver y Ch e ck list
W a r r a n t y Re g is t r at i o n
Cust om er Nam e Web Refe rr al Code
Add re ss City Sta t e Zip
Phone Emai l
VI N (l ast 8) Dat e of Pur ch as e
TH E BRA UN CO RPOR ATI ON M OBI LI TY CON VERS I ON S ERV I CE AG REEM ENT
This ag r eem en t i s int e nd ed t o cl ar if y t h e ser v ice r esp on sib il it i es t o th e Br au n m o bi lit y conv er sio n af t er t h e in it i al d eli v er y of t h e
veh icle . Thi s a gr e e m e n t sh a l l be ex e cu t e d a nd ele ct r o n ic a ll y su b m i t t e d t o Br a u n w i t h e a ch c on v e r sio n s a le .
List ed b el ow i s th e id en t if ica t ion of th e Br au n au t ho ri zed sellin g Mo bi li ty Retai le r, and t he Br au n a ut h or iz ed lo cal se rv i cin g
Mobi li t y Ret ai ler who h as ag r eed t o ser vi ce th e mo bili ty c onv ersi on po rt ion o f th is ve hicl e per t he appl icab le Bra un ser vi ce
ma nu al s and g ui del in es.
By sig ni n g bel ow , t h e pu r cha ser o f t h e m ob ili t y co nv er si on a ck no wl ed ge s th e ad opt i on o f t h e loca l ser v ici ng Mo bi li t y Ret ai ler as
th e pr ima ry p rov id er of se rv ice fo r th e m obil ity conv ersi on p ort ion o f th is ve hicl e. All lo cal ser vi cing r et aile rs m ust b e an
aut h or i zed Br au n Mo bi li t y Ser v ice e xc ell en ce Ret ai ler (MSE- cer t if ie d in v eh i cle co nv er si on s) .
Shou ld t he ow ner of th e m obil ity conv ersi on r equ ire se rv ice out side th e loca l serv ici ng ar ea, t he y m ay t ake t he m obi lit y
conv e rs ion t o a ny Brau n au t ho r ize d m ob il it y co nv er si on r e t ail er l oca t ed w it h in t h e Uni t ed St a t es. I f t h e ow n er n eed s assi st an ce
in id en t if y in g a loc al ser v ic in g m ob il it y r et a il er , t h ey m a y ei t he r cal l 1 - 80 0 - THE- LI FT, or c hec k t h e Bra un w eb si t e at :
ww w. bra una bili ty .co m.
Not e: Thi s agr eem en t o nl y ap p lie s to t h e ser v ici ng o f t he Br a un m o bi li t y co nv er si on . Anc ill ar y e qu ip m en t , su ch as t ie d ow n s or
han d co nt r ol s, w il l be t h e re spo nsi bi li t y of the m o bi lit y ret ai le r t ha t i nst a ll ed t h ose p ro du ct s an d wi ll n ot be cov er ed u nd er the
Bra un m ob il it y co n ve rs ion w a rr a nt y . I f t h er e ar e issu es r ela t in g t o t he ch as sis an d/ o r con v er sio n , it wou ld b e in t h e best int e re st
of t he m o bi li t y v eh icl e ow ner to co nt ac t t h e Bra un a ut h or i zed l oca l ser v ici ng Mo bi lit y Ret aile r list ed b elow b efo re ta kin g th e
veh ic le t o t he ir l oca l car d ea ler .
Reta iler Si gna tu re
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Se ll in g M o bi li t y R e t a il e r w il l b e t h e se r v ic in g c om p a ny
Se ll in g M o bi li t y V e h ic le R e t a il e r
Nam e Deal er #
Addr ess
City Sta t e Zip
Phone
Th e fol low ing co mp an y to p ro vid e se rv ice :
Loca l S er v i ci ng M o b il it y Ret 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 cle an a nd d am a ge - fr ee
Spar e ti re an d ja ck lo cat ion
Oper at i on o f r em ot e co nt r ol
Magn et i c ent r y ( i f ap pl ica bl e)
Ext er io r act i v at io n of p ow er door , k n eel in g an d r am p
Manu al op erat ion of doo r and r am p fr om ex te rio r
In t er io r
I n t e ri o r
Gaug es an d in st r um en t at io n
Locat i on o f in t er io r sw it ch es t o op er at e ac cessi bl e
fea tu res
Manu al op erat ion of doo r and r am p fr om in te rio r
Oper at i on o f t ie - do wn s
Oper at ion of r oll & t um bl e seat ing ( if ap plic able )
Oper at i on o f sea t b elt s
Locat ion o f Bra un con tr oll er
Add i t io n a l
Revie w bot h OEM and Br aun ow ner 's m anu als
Expl ain t he To yot a Ser vice Ex chan ge I nf orm at ion
Progr a m ( To y ot a Cha ssis On ly )
Expl ain r ec om m en de d pr ev en ti ve m ai nt en an ce an d
serv ice schedu les
Expl ain pro ced ur es f or w ar r an t y r ep ai r w or k
In f or m Cu st om er of deal er sh ip ser v ice h ou rs
Adv ise Cus t om e r t o re cei ve a nd m a in t ai n a sig ne d
reco r d of al l ser vi ce wo rk per for m ed
Com pl et e an d re t ur n w ar r an t y r eg ist r a ti on t o a ct iv at e
war r an t y
List a ll af t er m ar ket equ ipm e nt . Use b ra nd n am es an d
mo del n u m ber s wh er e po ssib le
I h ere by ack no wled ge t hat the m obili ty d evi ces app lica ble t o my veh icle h ave b een d emo nst rat ed for m e, a nd I full y un der sta nd
and c an op er at e t h is eq ui pm e nt . I hav e be en ad v ise d t ha t w h eel cha ir s m ay n o t m ai n ta in t h ei r in t eg r it y i n t he e ve nt of a
coll isio n. I h ere by r elea se and h old h ar mle ss th e Orig ina l Vehi cle Man ufa ctu rer , The Br au n Corp ora tio n, a nd it s ind epen den t
deal ers f rom a ny l iabi lit y ass oci at ed w i th inj u ry to m y p er son a nd p r op er t y as a r esu lt of m y us e of a w he elch ai r d ur in g a
coll isio n. I h ave r ead an d und ers tan d th is ent ir e for m, i nclu din g all di sclai me rs and t he Br aun fact ory Limi ted W arr ant y. A ll of
th e in fo r m at io n I hav e pr ov id ed i s cor re ct .
Cust o m e r :
I ack n ow le dg e t ha t al l it em s che ck ed h av e be en r ev ie we d wi t h
me .
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Cust om e r Sig n at u re / Dat e
Sa le s Con su l t a n t :
All it em s ch eck ed h av e bee n re vi ew ed w it h t he cu st om er .
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Consu lt a nt Sign at u re / Dat e
The de ale r ag r ees t o el ect r on ic all y su bm it th is com p le t ed Mob il it y Co nv er si on Se r vi ce Agr ee m en t t o Br a un Ab ili t y im m ed ia t ely
aft e r t he cu st om e r r ev ie w t ak es pl ace . Add it i on al ly , t h e dea ler agr ees t o m ai nt a in a co py o f t h is ex ecu t ed d ocu m en t , w it h t h e
app rop ria te si gna tu res af fix ed, f or a p eri od of si x ( 6) y ear s.
To ens ure t ha t com pl ete d reco rds a re m ain tai ned b y t he dea ler , Bra unA bili ty s hall p eri odi cally audi t t he ap plica ble r ecor ds t o
det er min e dea ler co nfo rm anc e. The de aler a gr ees to c oope rat e wi th Br au nAbi lit y in p rov idi ng co pies o f th ese re cord s. Failu re t o
com ply w it h th ese ter m s may nu lli fy an y oblig at i on t h at Brau nA bi lit y may hav e to p ay w ar r an t y cl ai m s sub m it t e d by t h e de al er .
I ac kno wle dge t he ab ov e agr eem ent .
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