Warranty Registration

If your new product included a warranty registration form, please complete this electronic form, or fill out the card included with your product to ensure that you receive valuable warranty information.

Providing the warranty information ensures:

• Service coverage to your system for the entire warranty period
• Compliance with FDA regulations that require medical devices and their locations be registered
• Keeps you informed of product enhancements, promotions and other programs

To register your product, please fill out this form. Please note: green-highlighted fields that are required.

Product 1:
Install Date		Serial Number
Product		Model Number
Product 2:
Install Date		Serial Number
Product		Model Number
Product 3:
Install Date		Serial Number
Product		Model Number
Customer Name		Institution Name
Street Address		City
State	AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip
Telephone		Country
Fax		Email
Installed By		Sales Person
Dealer Rep		Rep Affiliation
Please Send Me More Information On:
Ambulatory BP Monitors		Defibrillators
ECG Data Management System		Electrocardiographs
Exercise Stress Systems		Holter Analysis Systems
Pulse Oximeters		Rehabilitation Telemetry Systems
Spirometers		Supplies and Accessories

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