Warranty Form

Is there something wrong with your product and want to send it back? This can be done by using the form below. Fill in each field completely, so we can process. Process your return as soon as possible This form is not fully completed? Then we can not help you. Should you have any questions please feel free to contact us at 0167-57 30 20.

Product


Registration Type *
Manual wheelchair
Elek Troll Chair
Mobility Scooter
Care and mobility products

Order of reference *


Serial Number *


Product name *


Delivered on (date) *


Reason for return *
Manual wheelchair
Elek Troll Chair
Mobility Scooter
Other, namely:


Any comments for reasons of return:


Contact


Name *



Street address *


Zip Code *


Location *


Company Name


Country *


Phone *


E-mail address *


I accept the General Terms & Condition



Fields marked with * are mandatory.

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