Online Warranty Registration
** Seller Information **
Company Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
Website URL:
** Purchaser Information **
Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
Date Installed:
Product Bought:
Lift N Go Model 210
Tilt N Tote Plus Model 004
Tilt N Tote Model 001
The Tote Model 003
Swing Away Model 130
Please tell us about your
Chair or Scooter:
Make:
Model:
Please select your reason(s) for Purchasing WheelChair Carrier products:
Features/Benefits
Product Reputation
Warranty
Style/Design
Price
Durability
Easy to Maintain
Dealer Recommendation
Please enter any additional comments:
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