EZ Lock – The World's First Choice for Quality Wheelchair Docking Systems

Date(Required)

Serial Number(Required)

EZ Lock Model #(Required)

BL-6290

EZ-8202

EZ-lbot

Installing Dealer(Required)

Dealer Branch Location(Required)

Dealer Signature(Required)

By signing you affirm that the EZ Lock installation is in compliance with the guidelines prescribed by EZ Lock and in accordance with the installation instructions provided. In addition you affirm that the end user has been thoroughly and adequately instructed in the proper use of the EZ Lock Wheelchair Docking System.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Important Information(Required)

Read the user's instructions

Always wear your vehicle mounted lap & shoulder seat belt.

Stabilizer must be used for all driver applications.

Vehicle's ignition must be in the OFF position in order to release the wheelchair.

Ensure that your wheelchair is fully locked before starting your vehicle.

See your authorized dealer for routine maintenance at least every six months.

Customer Signature(Required)

By signing you affirm that the installing dealer has provided you with the User's Instructions and has thoroughly and adequately instructed you in the proper use of the EZ Lock Wheelchair Docking System.

EZ Lock Warranty Form