Warranty Registration Form

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

Product Model

Serial Number

Date Purchased

Dealer purchased from

Title

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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