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Warranty Registration
 
 
   
  PURCHASER INFORMATION:
   
  Purchase Date: --
   
  Purchased by
     
  Name:
  Business Name:
  Address:
  City:
  Province:
  Postal Code:
  Phone:
  Email:
     
   
  DEVICE INFORMATION
   
  Device:
     
 
   
  Device Serial Number:
 
   
  Handpiece Serial Number: (if applicable)
 
   
  Date of Purchase:
 
   
  DEALER INFORMATION:
     
  Dealer:
  Dealer Address:
  Dealer City:
  Dealer Postal Code:
  Contact Number