Thank you for purchasing your product! Please complete all of the information below. This form should be submitted within 30 days of original purchase for proper warranty registration. Additional restrictions may apply.

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Product Registration

Please review all the information below and submit for processing.

Product Details

Product #{{product.index}}

Serial Number: {{product.serialNbr}}

Model: {{product.partNumber}} - {{product.partDesc}}

Date of Purchase: {{product.purchaseDate}}

Country of Purchase: {{product.countryValue}}

Where did you purchase this product?: {{product.purchaseLocationName}}

Rebate & Warranty Information

Purchase Price of Product that Qualifies for Rebate: {{product.purchasePrice | currency}}

Store Where Purchased: {{product.otherStore ? product.otherStore : product.storeName}}

Receipt(s): {{product.receipt}}

UPC Code(s): {{product.upc}}

Rebate Code: {{product.rebateCode}}

Bonus Code: {{product.bonusCode}}

Warranty Code: {{product.warrantyCode}}

Giveaway: {{giveaway.title}}

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Customer Information

First Name: {{firstname}}

Last Name: {{lastname}}

Email Address: {{email}}

Telephone: {{phone}}

Country: {{country}}

Zip Code: {{zip}}

Address 1: {{addr1}}

Address 2: {{addr2}}

City: {{city}}

County: {{county}}

Province: {{state}}

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