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Serial # _______________
CUSTOMER TO COMPLETE DEALER TO COMPLETE
Mr./Mrs./Ms.
___________________________ ________________________________
Your Name (Please Print) Company Name
___________________________ ________________________________
Address Dealer’s Address
___________________________ ________________________________
City, State, Zip Code City, State, Zip Code
___________________________ ________________________________
Telephone Number Dealer’s Telephone Number
___________________________ ________________________________
Year / Make / Model of Vehicle Date of Installation / Purchase
________________________________
Dealer’s Signature
“Proof of Purchase” which includes the store name and date of purchase must
accompany all warranty returns.
It is the purchaser’s responsibility to keep this card for any future warranty
service.