
Copyright 12-12 FORM #WV-122
I have inspected this equipment and nd it in correct working condition. To the best of my knowledge,
the customer and his/her personnel are aware of, and agree to the above procedures.
Signed: ________________________________________________________ Date: ______________
(Dealer Representative)
The equipment has been thoroughly checked by the above named dealer representative, and I am
satised with his/her instructions. I have also read, understand, and agree to reverse side of page.
Signed: ________________________________________________________ Date: ______________
(Customer)
IT IS VERY IMPORTANT THAT THIS FORM IS FILLED OUT COMPLETELY & ACCURATELY. IF WE
CANNOT READ THE PURCHASER’S INFORMATION OR IT IS INCORRECT, OUR CUSTOMER LIST
WILL NOT BE ACCURATE.
IMPORTANT - THIS FORM MUST BE RETURNED TO THE
CUSTOMER DATA DEPARTMENT WITHIN TEN
(10) DAYS IN ORDER TO VALIDATE WARRANTY
Customer Data Department
6750 Millbrook Road
Remus, MI, USA 49340
Phone: (800) 952-0178 in USA
Phone: (989) 561-2270
Fax: (989) 561-2273
E-mail: www.banditchippers.com
WARRANTY VALIDATION FORM
(HAND FED CHIPPER)
1. ____ Customer has been instructed and understands operation and all safety aspects of operating the equipment.
2. ____ Customer has been instructed and understands that everyone within 100 feet of machine must wear personal
safety equipment (i.e. hard hat, face shield, safety glasses, gloves, ear protection, etc.)
3. ____ Customer has been instructed and understands equipment maintenance schedules, procedures, and that it is
their responsibility to perform maintenance that includes periodic relief valve adjustments, retightening all fasteners as
needed,periodiccleaningofowdivider,clutchandbeltadjustments,etc.
4. ____ Customer has been advised and understands not to reach into the infeed hopper with hands or feet. The
machine operators must always be located within easy reach of all feed control and shut down devices.
5. ____ Customer understands that the wooden push paddle must be used to push small debris into the chipper and,
that they are not to reach or kick debris into the infeed hopper area of the machine.
6. ____ Customer understands the purpose of and how to operate the last chance device, and if used the machine has
been operated in an unsafe manner. Customer understands to never attempt to override any safety devices or guards.
7. ____ Customer has been instructed and understands to always remove the ignition key and completely disconnect
battery from cables, wait for the chipper disc/drum to come to a complete stop, and to install the disc/drum lock before
performing any type of maintenance on the machine. Allow all the time necessary for the disc/drum to come to a complete
stopbefore opening the disc/drum housing orstartinganymaintenanceor service procedures. Customer has been shown
and understands the purpose of the beltshield inspection hole and to not attempt any maintenance until belts are visually
conrmedtohavecometoacompletestop.
8. ____ Customer has been instructed and understands:To Not operate this machine withoutthefactoryapprovedhood
pin assembly in place and padlocked. To Not operate this machine with any type of make shift hood pin. To Not operate
this machine under any circumstances with the chipper hood open or unsecured.
9. ____ Customer has reviewed and understands limited warranty and all written and visual instructions.
10. ____ Customer has received, been advised, and understands the manuals and the Safety/Service video supplied
with the chipper. A video is supplied for equipment models as available.
11. ____ All Danger, Warning andOperational decals areproperly displayedon equipment andfully understood by customer.
12. ____ Customer has been instructed, understands, and agrees that all potential operators must: See the supplied
video, be instructed on all the Danger, Warning, and Operational decals, read the manual, and follow the procedures.
13. ____ I have been advised of all safety options.
PURCHASER INFORMATION:
Company Name __________________________________ Contact Name _____________________
Mailing/Street Address ________________________________________ City __________________
State ______________________ Zip Code _________ Phone Number ( ___ ) ________________
E‑mail ____________________________ Chipper Model No. _________ Serial No. ____________
Date Chipper Put Into Service _________ Engine Make & S/N _______________________________
DEALER / SELLER INFORMATION:
Dealer/Seller Name _______________________________ Contact Name _____________________
Mailing/Street Address ________________________________________ City __________________
State ______________________ Zip Code _________ Phone Number ( ___ ) ________________