Warranty Registration Form

Warranty Registration Form

Please ensure all information provided is correct to ensure full warranty coverage.

Product Model*

Select or enter value

Serial Number*

Date Purchased*

Dealer purchased from*

Title

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First Name*

Last name*

Address Line 1*

Address Line 2

Postcode*

County

Phone Number*

Email Address*

What was your main reason for purchasing this product?

Other comments?

We would love to hear your feedback! What do/don't you like about the product?

Acceptance

I confirm that the mobility dealer stated above has fully demonstrated how to use the product safely and has explained the product safety & comfort features.*

I confirm that I have read and fully understand the instructions for use and how to operate this product safety without putting others or myself at risk of harm.*

I confirm that I am fully competent to use this product safely without putting others or myself at risk of harm.*

Tick this box if you would like to be kept up to date with helpful Komfi-Rider product news!

I am happy for Komfi-Rider to share my feedback for marketing or development purposes.

No problem if you do not want us to!

Date Completed*

Send me a copy of my responses

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