LIFT-ALL Transfer of Ownership

Transfer of Ownership Registration

If you recently purchased this LIFT-ALL aerial device as used equipment, ANSI and OSHA require you to complete a copy of this document and return it to Hydra-Tech, Inc., the original manufacturer of the aerial device, as soon as possible. It is important third parties purchasing used LIFT-ALL equipment do so in order to ensure our records are current should we need to contact owners of our equipment in the future.

If you purchased this LIFT-ALL aerial device new, you do not need to complete this document. A LIFT-ALL Warranty Registration E1019 document is mailed with the invoice for all new LIFT-ALL's. Purchasers of new LIFT-ALL aerial devices should complete E1019 as soon as possible and return the white copy to us. If you did not receive your copy of E1019 for some reason, or you prefer electronically submitting the form, we have a new Online version for your convenience.

ALL FIELDS ARE REQUIRED

This submitted form is to acknowledge that on: (Date)mm/dd/yyyy.mm/dd/yyyy

Ownership of:

LIFT-ALL Model:

Serial Number:

Aerial Device was transferred to:

Company Name:

Address:

City: State: AL AK AZ CA CO AR CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VI VA WA WV WI WY Choose... Zip Code: 5-digits.

Telephone Number: 10-digits. 10-digits.Fax Number: Invalid format. 10-digits.10-digits.

Email Address Invalid format.

This Aerial Device was purchased from:

Company Name:

Address:

City: State: AL AK AZ CA CO AR CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VI VA WA WV WI WY Choose... Zip Code:

Telephone Number: 10-digits. 10-digits.Fax Number: Invalid format. 10-digits.10-digits.

Email Address Invalid format.

ANSI and OSHA require that the Purchaser notify the Manufacturer of their name and address within 60 days of transfer of ownership. The Seller must provide the Purchaser with two (2) copies of the Manufacturer's manual for the aerial device.

By selecting "I Agree" below, you acknowledge the validity of this form and honesty of fulfillment.

I Agree must be selected before submitted.

By clicking "Submit", you will be sending this completed form to Hydra-Tech, Inc. If the form is not filled-out correctly, please review the highlighted areas above. You will be notified of a successful submission.