HIGH GROUND CONVERSIONS CUSTOMER AND WARRANTY REGISTRATION FORM

DEALER TO ASSURE THAT THIS FORM IS COMPLETED AND RETURNED WITHIN TEN (10) WORKING
DAYS AFTER PDI AND DELIVERY IS PERFORMED. WARRANTY CAN BE DOWNLOADED HERE.

Owner's Name:

Address:

Address Line 1

City

State

Zip Code

Phone Number:

Delivery Date:

Serial Number:

Email Number: Address:

Dealer's Name:

Dealer's Email

Dealer's Phone Number

Dealer's Address:

Address Line 1

City

State

Zip Code

Model Year:

Make:

Model:

Notes:

I have had the opportunity to review the HIGH GROUND CONVERSIONS Limited Warranty during the purchase of this ambulance. I have been given the opportunity to make notations in the space provided and have observed or received satisfactory explanation to all questions regarding the items listed during this delivery process.

Purchaser's Signature

Clear Signature

Date:

Dealer's Signature:

Clear Signature

Date:

HIGH GROUND CONVERSIONS CUSTOMER AND WARRANTY REGISTRATION FORM

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