Copyright 11-06 FORM #WV-124
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
WARRANTY VALIDATION FORM
(STUMP GRINDER)
PURCHASER INFORMATION:
Company Name _____________________________________ Mailing/Street Address __________________________
City __________________________________________ State _________________ Zip Code _________________
Telephone Number ( ____ ) _______________________ E-mail ___________________________________________
Contact Name ___________________________ Stump Grinder Model No. ___________ Serial No. _____________
Date Put Into Service _____________________ Engine Make & S/N _______________________________________
DEALER INFORMATION:
Dealer Name _______________________________ Mailing/Street Address __________________________________
City __________________________________________ State __________________ Zip Code _________________
Telephone Number ( ____ ) ___________________________ Contact Name _________________________________
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 (30 m) 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 (i.e. retightening all fasteners as needed, clutch and
belt adjustments, etc.)
4. _______ Customer has been advised and understands not to reach near the cutter head with hands or feet or to be
locatedneardebriseldwithenginerunning.Themachineoperatorsmustalways be located within easy
reach of all control and shut down devices.
5. _______ Customer understands to not start grinding a stump without checking for power lines, water lines, sewer lines,
phone lines, etc.
6. _______ Customer understands the purpose of and how to operate the shut down/shut-off devices, and will not
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 cutter head to come to a complete stop, and to install the cutter head lock
before performing any type of maintenance on the machine. Allow all the time necessary for the cutter head
to come to a complete stop before opening the cutter head guard or starting any maintenance or service
procedures. Customer has been shown and understands the purpose of the beltshield inspection hole and to
notattemptanymaintenanceuntilbeltsarevisuallyconrmedtohavecometoacompletestop.
8. _______ Customer has been instructed and understands: To Not operate this machine without the factory approved
cutter head guard assembly in place. To Not operate this machine with any type of make shift cutter head
guard. To Not operate this machine under any circumstances with the cutter guard 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 videotape
supplied with the grinder. A videotape is supplied for equipment models as available.
11. _______ All Danger, Warning and Operational decals are properly displayed on equipment and fully understood by customer.
12. _______ Customerhas beeninstructed,understands, andagreesthat allpotentialoperatorsmust: Seethesuppliedvideotape,
beinstructedon alltheDanger,WarningandOperationaldecals, readthemanual andfollowtheprocedures.
I have inspected this equipment and nd it in correct working condition. To the best of my knowledge, the customer and
his personnel are aware of, and agree to the above procedures.
Date: _______________________________________________ Signed: ________________________________________
The equipment has been thoroughly checked by the above named dealer representative, and I am satised with his
instructions.
Date: _______________________________________________ Signed: ________________________________________
(Dealer Representative)
(Purchaser)
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
