PRODUCT REGISTRATION FORMand INSPECTION REPORT Box 760, 275 Hespler Ave, Winkler, Manitoba R6W 4A8 T: (800) 418-9461 P: (204) 325-4195 F: (204) 325-8116 www.convey-all.com conveyors@convey-all.comBuyer's Name(Required) Address(Required) Street / Road Address City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required) Email(Required) Dealer Company Name(Required) Dealer Email(Required) Salesperson Name(Required) Dealer Township(Required) City Phone(Required) Model Number (eg. 1658TL, CST1500)(Required) Serial Number(Required) Delivery Date(Required) DD slash MM slash YYYY General Purpose(Required) Private Commercial Date of Registration(Required) DD slash MM slash YYYY Engine Serial Number(Required) Unit Inspection(Required) All Fasteners Tight Engine/Hydraulic Fluid Levels Checked Hydraulic Hoses Good, Fittings Tight Machine and All Bearings Lubricated Conveyor Belt Aligned and Tensioned Conveyor Belt Moves Freely Conveyor Tube Raises and Lowers Smoothly Unit Steers and Drives Smoothly Tire Pressure Checked Lift Cables adequately secured Check and adjust all hopper seals/belt contact Engine Mounted tightly to Unit All heat guards installed and fixed tight Select AllSafety Inspection(Required) All Guards/Shields Installed and Secured All Safety Decals Clear and Legible Reflectors Installed and Clean All Lights are Clean and Working Reviewed Operating and Safety Instructions Select AllHow did you originally hear about this product?(Required)Search and found on Google for productsAlready aware about products and contacted local DealerWord of mouthFacebook or InstagramTwitterOtherOther (Please tell us where where you heard about this product)(Required) The Salesperson has thoroughly instructed me on the above described equipment. The review included the content of the Operator’s Manual, equipment care, adjustments, safe operation and warranty policy. The above equipment and Operator’s Manual have been received by me.Buyer's Name(Required) Date(Required) DD slash MM slash YYYY Buyer Signature(Required)CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
