©2007,2001 Bruno Independent Living Aids, Inc.® SRE-2000 Operator 03-14-2007
2
PRODUCT REGISTRATION FORM
Bruno is pleased to provide you with this
mobility-enhancing product.
The Product Registration Form is shipped in
a plastic bag with this manual. It is very
form at your earliest convenience so that we
may complete the warranty registration process
for your unit.
The serial number
to the manual, as well as on the unit itself.
Serial and model numbers must be provided
or ordering parts. We encourage you to keep
this information readily available at all times.
Please Note: The warranty for the SRE-2000
Stairway Elevator is rendered null
and void if the unit is installed by
anyone other than an authorized
Bruno dealer.
Best wishes from the Bruno Team.
Product Registration Form
Please print in CAPITAL letters.
Last Name ______________________________________
First Name _____________________________ M.I._____
Street Address ___________________________________
City ________________________________ State ______
Zip/Postal Code/Country ___________________________
Email Address ___________________________________
Telephone No. ___________________________________
Date of Purchase (mm/dd/yy) _______________________
Installer (if different than seller) _______________________
Serial No._________________
Bruno product information here.
Model No._________________
Please be assured that Bruno does not share or sell the information you provide.
Where did you hear about Bruno? CHECK ALL THAT APPLY.
doctor/therapist
Bruno dealer
AARP publication
Internet
local newspaper
Who was the primary decision maker for this purchase?
user of product
family member
friend
Which of the following health issues are of concern to you? CHECK ALL THAT APPLY.
spinal injury
arthritis
diabetes
stroke
heart disease
TV
radio
other (please tell us):
__________________________
__________________________
__________________________
care giver
doctor/health care provider
post polio
muscular dystrophy
multiple sclerosis
emphysema
other (please tell us):
__________________________
__________________________
__________________________
include apartment no, suite no.
Rev. 10/06
©2006,2005 Bruno Independent Living Aids, Inc.®
Please rate your satisfaction with your Bruno dealer:
excellent good average poor
Please rate your satisfaction with your Bruno product:
excellent good average poor
Bruno reserves the right to use comments indicated on this form in its on-line, video, audio and printed
materials. Names will be abbreviated to ensure the privacy and anonymity of the individual.
SAMPLE
